110Lu Lung Abscess

  • 61-year-old –
    • alcoholic male presented with
      • 3-week cough productive of phlegm and blood,
      • right-sided pleuritic chest pain,
      • fever, tachycardia and
      • 20-lb weight loss over the past 4 months

CXR Lung Abscess with Air Fluid  Level

CXR Lung Abscess with Air Fluid  Level  61-year-old – male presented with 3-week cough productive of phlegm and blood, right-sided chest pain, and 20-lb weight loss over the past 4 months
CXR showed consolidative opacity in R upper lobe with two intrinsic air fluid levels concerning for abscess.
Ashley Davidoff MD TheCommonVein.net 110 LU  136164
  • Differential diagnosis included
      • aspiration, given history of alcohol use disorder, and
      • TB given prior homelessness,  and
      • malignancy given recent 20 lb weight loss.

CT Cavitating Lung Abscess 

CT Lung Abscess
CT chest showed a cavitating right upper lobe abscess, with a region of consolidation and a smaller region of ground glass opacity
Ashley Davidoff MD TheCommonVein.net 110 LU  136165
  • started on IV Unasyn q6h,
  • TB was ruled out with 2 PCRs and 2 smears.
  • Sputum culture showed
      • 1+ gram negative rods, and 1+ gram positive cocci in pairs.
    • MRSA PCR was negative.
  • Continued IV Unasyn , then
  • switched to Augmentin po.
  •  improved clinically, was  feeling better,

1 Month Later
Resolving Consolidation with Increased Cavity Size

CXR 1 Month Later Resolving Consolidation with Increased Cavity Size
CXR 1 month later shows decreased consolidation and cavity size has become more prominent.
Ashley Davidoff MD TheCommonVein.net 110Lu  13166

1 Month Later Decreased Consolidation and GGO
Increased Cavity Size

1 Month Later Decreased Consolidation and GGO Increased Cavity Size
CT in the axial plane, 1 month later shows shows decreased consolidation and cavity size has become more prominent.
Ashley Davidoff MD TheCommonVein.net 110Lu 136167

6 Months Later
Ongoing Improvement

CXR 6 Months Later Ongoing Improvement
Frontal CXR 6 months later shows that the abscess cavity is continuing to get smaller
Ashley Davidoff MD TheCommonVein.net 110Lu 136168

6 Months Later Ongoing Improvement Persistent Cavity

6 Months Later Ongoing Improvement Persistent Cavity
CT 6 months later shows improvement but with persistence of a cavity
Ashley Davidoff MD TheCommonVein.net 110Lu 136169