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Joseph Junewick, MD FACR
over 7 years ago
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Pulmonary Abscess

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 4 years ago
Updated: about 1 year ago
Tags: PEDS
Modality/Study Types: CT
Activities:
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History

12 year old with cough.


Case Images


Diagnosis

Pulmonary Abscess

Findings

CT – Initial images with mediastinal and lung windowing show thick walled intrapulmonary collection with air-fluid level and adjacent atelectasis. Follow-up scan shows persistent post-inflammatory pneumatocele.

Discussion

A pulmonary air-fluid level on imaging suggests the presence of a lung abscess. Lung abscess is most commonly associated with aspiration pneumonia and septic pulmonary emboli often related to anaerobes, Staphylococcus aureus, and Klebsiella pneumoniae. While lung abscess only requires appropriate antibiotics and supportive care, prompt diagnosis is necessary to minimize morbidity and mortality. A lung abscess with an air-fluid level can be differentiated from empyema with bronchopleural fistula by measurement and comparison of the lengths of the visualized air-fluid level on orthogonal chest radiographs. Because of the characteristic spherical shape of a lung abscess, an associated air-fluid level typically has equal lengths on posteroanterior and lateral chest radiographs. Additionally, a lung abscess usually forms an acute angle when it intersects with an adjacent pleural surface, and its wall is often thick and irregular. A pleural air-fluid level indicates empyema or bronchopleural fistula. Other differential diagnostic considerations for an intrathoracic air-fluid level include hemorrhage into a cavity, lung cancer, and metastatic disease.

Reference

Walker CM, AbbottGF, Greene RE, et al. Imaging Pulmonary Infection: Classic Signs and Patterns. AJR (2014); 202(3):479-484.



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