Presentation
Two weeks of chest pain, breathlessness and productive cough. Smoker. History of IV drug abuse.
Patient Data
Right upper zone consolidation with cavitating features and gas-fluid level.
No abnormalities in left lung. Cardiac silhouette normal.
Inflammatory mass with cavitation in the right upper lobe and right middle lobe. Smaller discrete abscesses in the superior right lower lobe.
Tree-in-bud appearance consistent with infective bronchitis.
No lymph node enlargement.
Unremarkable abdominal viscera.
Reduction in fluid component but widespread residual consolidation in right lung.
Small volume of pleural fluid in right upper and mid-zones.
Case Discussion
This pulmonary abscess seemed to make some progress with intravenous and oral antibiotic therapy.
Although a number of potential causes were investigated (through multiple blood cultures, sputum cultures, bronchalveolar lavage washouts and cytology, TB, HIV tests, cardiac echo) no infective source was isolated.
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