Presentation
Cough with productive sputum and fever for 3 days.
Patient Data
Thick-walled cavitary lung lesion at the right lower lung zone with adjacent consolidation.
Both costophrenic angles are sharp.
No obvious enlargement of the mediastinum.
A large cavitating lesion with an irregular thick wall and air-fluid level is seen at the right lower lobe, involving the superior, posterobasal, and laterobasal segments of the right lower lobe. The luminal surface is irregular. No obvious communication is demonstrated between this cavitation with the adjacent left lower lobe bronchial airways. No obvious enhancing solid component.
Pulmonary consolidation and ground glass opacities adjacent to this cavitating lesion with air bronchograms are seen within the consolidation.
A few subcentimeter lung nodules are seen at the right upper lobe, the superior segment of the left lower lobe, and the right lower lobe.
No pleural effusion bilaterally.
An enlarged mediastinal lymph node at the subcarina.
Borderline cardiomegaly.
Case Discussion
Right lower lobe cavitating lesion, where in this clinical context of high white blood cells and inflammatory marker (high C reactive protein), the likely differential diagnosis includes pulmonary abscess (tuberculosis should also be considered). Other differential diagnoses to consider are cavitating bronchogenic carcinoma.
The patient has a background history of uncontrolled diabetes mellitus.
Bronchoalveolar lavage culture isolated mixed growth of E. Coli, Klebsiella, and Pseudomonas. The patient was treated with 6 weeks of antibiotics.
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