Case 28

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was an 18 year old male with fever, cough, and halitosis. The patient's past medical history was remarkable for diabetes mellitus.

Clinical Physical Exam:
Febrile.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Pneumonia

Imaging Findings:
Outside PA and lateral chest films from the first hospital day showed an air fluid level in the right lower lobe. This lesion was better demonstrated on a chest CT exam performed the next day.

Images 1 and 2

Image 3

Imaging Differential Diagnosis:
Pulmonary abscess

Operative Findings:
On the second hospital day, after the chest CT exam, this pulmonary abscess was drained under ultrasound and fluoroscopic guidance and a sump catheter was left in place. An air leak was later noted between the bronchus and the lung abscess so the abscess catheter was placed to a water seal in a Pleurovac.

Pathological Findings:
The cultures of the abscess grew out Strep milleri, an anaerobe.

Final Diagnosis:
Lung Abscess

Follow-up and Prognosis:
The patient had an uncomplicated post-drainage course.

Similar Cases:
Case 5, Case 52

References:

• Paediapedia
• WebPath
• WebPath
• WebPath
• WebPath
• WebPath
• WebPath
• WebPath

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