MyPACS.net: Radiology Teaching Files > Case 7526501

previously visited 061205 LUNG ABSCESS
Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 2 year old male
History: Shortness of breath and poor activity since last night.
Fever(+).
Images:[small]larger

Fig. 1: Chest X-ray on day 1 noon

Fig. 2: Chest X-ray on day 1 afternoon

Fig. 3: Chest X-ray on day 3

Fig. 4: Chest X-ray on day 8 morning

Fig. 5: Chest X-ray on day 8 evening

Fig. 6: Chest X-ray on day 10

Fig. 7: Chest CT with IV contrast on day10 Axi

Fig. 8: Chest CT with IV contrast on day10 Axi

Fig. 9: Chest CT with IV contrast on day10 Cor

Fig. 10: Chest CT with IV contrast on day10 Cor

Fig. 11: Chest CT with IV contrast on day10 Sag

Fig. 12: Chest CT with IV contrast on day10 Sag

Fig. 13: Chest CT with IV contrast on day10 Axi
Findings:

Chest X-ray on day 1 noon:
1. Peribronchial infiltration in both lungs,
   pulmonary congestion or pneumonia should be differentiated.
2. Small left pleural effusion, nature to be determined.
3. Presence of electrocardiographic leads.

Chest X-ray on day 1 afternoon:
1. Progressive infiltration in both lungs.
2. Presence of endotracheal tube.

Chest X-ray on day 3:
1. Progressive consolidation in both lung.
2. Right side deviation of mediastinum.

Chest X-ray on day 8 morning:
1. Progressive left pleural effusion.

Chest X-ray on day 8 evening:
1. Small lucent areas in left lung, suggesting pneumoatocele.
2. Left hydropneumothorax under chest tube in place,
   may due to bronchopleural fistula and empyema.

CT scan of chest with IV contrast on day10:

1. Diffuse alveolar densities in both lungs, in favor of pneumonia.
2. Multiple round air spaces in left lung, in favor of pneumoatocele.
3. Focal fluid accumulation in mediastinal side of left lower lung
   with poor contrast enhanced adjacent lung tissue,
   suggesting lung abscess.
4. Right side deviation of mediastinum with secondary dextrocardia,
   may due to left tension hemopneumothorax under two chest tubes
   in place.
5. Small linear air in liver, pneumobilia or portal vein gas from
   pneumatosis intestinalis should be differentiated.

Diagnosis: 1. Pneumonia in both lungs with pneumoatocele and abscess in left lung.
2. Left bronchopleural fistula with tension hemopneumothorax.
3. Suspicious pneumobilia or portal vein gas.
Discussion: We transferred the patient to other hospital to surgical manangement.
(Pneumonia, lung abscess, sepsis, pancytopenia, disseminated intravascilar coagulation)
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Additional Details:

Case Number: 7526501Last Updated: 12-16-2006
Anatomy: Lung   Pathology: Infection
Modality: CT, Conventional RadiographAccess Level: Readable by all users
Keywords: lung abscess, pneumonia, pneumatocele, empyema, bronchopleural fistulaACR: 60.2161

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