Pulmonary abscess

Case contributed by Assoc Prof Frank Gaillard

Presentation

Background of Crohn's disease and immunosuppression.

Patient Data

Age: 65 years
Gender: Female

Plain film appearances at presentation

X-ray

Large pulmonary cavity with a small dependant air-fluid level within the left mid zone, in keeping with pulmonary abscess. Patchy airspace opacification more inferiorly within left lower zone. 
Scarring/atelectasis within lateral aspect of right upper zone.

Plain film appearances 5 weeks previously

X-ray

Frontal radiograph from 5 weeks previously demonstrates a clear left lung, raising the confidence that current appearances are infective in etiology.

CT

CT findings in keeping with the plain film appearances, demonstrating a large cavity within the left lower lobe, with an air-fluid level within.

Relatively extensive adjacent ground-glass changes and consolidation. Further areas of ground-glass change and consolidation in both upper lobes.

Small bilateral pleural effusions.

Case Discussion

Chest x-ray of a 65 year old woman, immunocompromised as a result of Crohn disease, demonstrates a large left sided pulmonary cavity with a small dependent air-fluid level. The wall is relatively thin.

CT confirms the abnormality as well as demonstrates extensive adjacent and separate areas of consolidation. Small pleural effusions are also present. Findings are in keeping with a large pulmonary abscess

Case courtesy of Bob Cook, MD. Western Memorial Regional Hospital Corner Brook, Newfoundland.

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