Saturday, April 18, 2009

Saturday April 18, 2009

Scenario: 47 year old male with history of alcohol abuse is admitted to ICU with one week history of fever, cough, hypoxia and dehydration. Following CXR is obtained. What is your major concern/diagnosis?




Answer: Acute necrotizing pneumonia with formation of cavity. (See right lower lobe thick walled cavity)

Cavitation seen in infectious disease is secondary to bacterial toxins and enzymes released by leukocytes, which then leads to tissue necorsis. The typical radiographic pattern is usually segmental homogenous consolidation and subsequent cavitation indicating an acute necrotizing pneumonia. The cavities are usually thick walled and may be multiple if the pneumonia is multilobar. Differential diagnosis includes neoplasm, post infarction, fungal disease, or tuberculosis.

Bronchoscopic lavage and CT scan may help in establishing diagnosis.

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