Pulmonary abscesses

Case contributed by Dr Phillippa Gray

Presentation

40 year old male presented with 2 week history of shortness of breath and productive cough. Had not responded to oral antibiotics so GP had ordered a radiograph

Patient Data

Age: 40
Gender: Male
X-ray

Multiple cavitating lesions are demonstrated in the left upper lobe and apical segment of left lower lobe. The two largest lesions demonstrate air fluid levels.

CT

Multiple bilateral cavitatory lung lesions with air fluid levels and underlying consolidation. There is background emphysematous change most evident apically.

Case Discussion

Patients history was remarkable only for recent dental work, which in lieu of any other source was presumed to be the original source of infection. Unfortunately, no specific organism was grown, but the patient presented with infective symptoms and biochemistry and responded clinically to a prolonged course of IV antibiotics. Screening and history for alternative causes were negative. Given the clinical course, the diagnosis was felt to be pulmonary abscesses.

Differential for cavitating lung lesions includes:

  • infective: pulmonary TB, bacterial abscess, cavitating pneumonia, septic emboli
  • autoimmune: granulomatosis with polyangiitis, rheumatoid nodules
  • malignancy: primary and metastases
  • pulmonary infarct
  • pneumatoceles secondary to trauma (not a true cavity)
  • congenital causes

The mnemonic device CAVITY is sometimes used.

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Case information

rID: 61795
Published: 4th Aug 2018
Last edited: 14th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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