- 61-year-old –
- alcoholic male presented with
- 3-week cough productive of phlegm and blood,
- right-sided pleuritic chest pain,
- fever, tachycardia and
- 20-lb weight loss over the past 4 months
- alcoholic male presented with
CXR Lung Abscess with Air Fluid Level

CXR showed consolidative opacity in R upper lobe with two intrinsic air fluid levels concerning for abscess.
Ashley Davidoff MD TheCommonVein.net 110 LU 136164
- Differential diagnosis included
-
- aspiration, given history of alcohol use disorder, and
- TB given prior homelessness, and
- malignancy given recent 20 lb weight loss.
-
CT Cavitating Lung Abscess

CT chest showed a cavitating right upper lobe abscess, with a region of consolidation and a smaller region of ground glass opacity
Ashley Davidoff MD TheCommonVein.net 110 LU 136165
- started on IV Unasyn q6h,
- TB was ruled out with 2 PCRs and 2 smears.
- Sputum culture showed
-
- 1+ gram negative rods, and 1+ gram positive cocci in pairs.
- MRSA PCR was negative.
-
- Continued IV Unasyn , then
- switched to Augmentin po.
- improved clinically, was feeling better,
1 Month Later
Resolving Consolidation with Increased Cavity Size

CXR 1 month later shows decreased consolidation and cavity size has become more prominent.
Ashley Davidoff MD TheCommonVein.net 110Lu 13166
1 Month Later Decreased Consolidation and GGO
Increased Cavity Size

CT in the axial plane, 1 month later shows shows decreased consolidation and cavity size has become more prominent.
Ashley Davidoff MD TheCommonVein.net 110Lu 136167
6 Months Later
Ongoing Improvement

Frontal CXR 6 months later shows that the abscess cavity is continuing to get smaller
Ashley Davidoff MD TheCommonVein.net 110Lu 136168
6 Months Later Ongoing Improvement Persistent Cavity

CT 6 months later shows improvement but with persistence of a cavity
Ashley Davidoff MD TheCommonVein.net 110Lu 136169