Presentation
Left sided pleuritic chest pain.
Patient Data
45 mm rounded opacity in the lateral left lower zone - concerning for possible malignancy.
Some further patchy opacification inferior to this at the left base.
Normal mediastinal and diaphragmatic contours.
A peripheral mass lesion measuring 3.9 x 3.5 x 3.3 cm with peripheral ground-glass opacity is noted in the left lower lobe, abutting the overlying pleural surface with no evidence of chest wall infiltration. This is low attenuation centrally and has a few small locules of gas within, suggestive of abscess formation.
No other pulmonary nodules or masses.
No mediastinal, hilar, supraclavicular or axillary lymph node enlargement. No pleural or pericardial effusion. No evidence of central pulmonary thromboembolism. No skeletal destructive lesions.
(The abdomen and pelvis were also scanned but identified no other significant pathology).
Almost complete resolution of the previously seen rounded opacity in the left lower zone, suggests the lesion is most likely infective/inflammatory. No new focal lung lesions. No pleural effusion. Normal mediastinal and diaphragmatic contours.
Case Discussion
The appearances on the initial chest X-ray look similar to what might be seen in round pneumonia. Round pneumonia is common in young children but not typically seen in adults due to interalveolar communication and airway collateralisation, something that is not present to the same extent in the pediatric population. Because these pathways exist in adults, the spread of infection is not limited to the same extent and lobar pneumonia may result.
In adults, when a rounded opacity is seen a pulmonary mass is perhaps the more likely diagnosis. In this case, the lesion resolved rapidly with antibiotic therapy and therefore an infective etiology was presumed most likely. The low attenuation center of the lesion and locules of gas suggest in this case early abscess formation.
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