061205 LUNG ABSCESS

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061205 LUNG ABSCESS

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Authored 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(+).

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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

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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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Note:

1. Lung abscess:
Areas of necrotic lung surrounded by zones of inflammatory consolidation.
In early stages, like a discrete pneumonic consolidation without definite cavity visualization.
May need surgery.

2. Pneumatocele:
Local air collection in infected lung.
May contain gas-fluid levels and difficulty differentiate from lung abscess
(thicker and often somewhat shaggy wall in late stage)
Usually self-limited without surgery.

3. Empyema complicated by bronchopleural fistula:
Pus and persistent air in pleural space after chest tube.
Surgery when persistent air leak after lung fully inflated under chest tube for several days.

By Dr. Tsao

--pedrad CSH, 2006-12-16 17:47:31

Additional Details:

Case Number: 7526501Last Updated: 02-19-2007
Rating:

2 ratings
Anatomy: Chest Pathology: Infection
Modality: CT, Conventional Radiograph

Access Level: Readable by all users
Keywords: lung abscess, pneumonia, pneumatocele, empyema, bronchopleural fistula

ACR: 60.2161Contained in:

hafiz,

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Case has been viewed 2308 times.

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