Radiographic Findings

A chest film taken 12/6/98 was normal.

A film taken 1/16/99 showed a left upper lobe consolidation with air bronchograms. What diagnoses should be considered? Answer

A film taken on the second admission, 1/27/99, shows cavitation in the area of previous consolidation and increased opacities in the remainder of the lung. What is the differential diagnosis now? Answer

Clinical summary Image 1

Table of Contents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer: A large consolidation can occur with a lobar pneumonia caused by S. pneumoniae or klebsiella or extensive bronchopneumonia caused by S. aureus, proteus, E coli, legionella, nocardia, or actinomycetes. The pattern is somewhat atypical for mycoplasmal, viral, and pneumocystis pneumonias, which are usually interstitial and appear as ground-glass, somewhat patchy densities. Additional considerations are aspiration pneumonia, pulmonary embolism, tuberculosis of a primary type behavior, fungal infection, hemorrhage, drug reactions, and eosinophilic pneumonia. With the rapid onset, bronchioloalveolar carcinoma (BAC) and lymphoma would be unlikely. Three smears for AFB were negative.

Return

Clinical summary Image 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer: The rapid cavitation suggests a necrotizing pneumonia--staphylococcal, Gram-negative, or anaerobic organisms. With neutropenia, aspergillus is high on the list, but aspiration pneumonia, pulmonary embolism, tuberculosis, and other fungal infections (e.g. mucor) remain. The rapid, rather complete cavitation would be unusual for pneumocystis pneumonia, in which thin-walled cysts grow and increase in number: cavitation of a previous consolidation is unusual. Cavitation is very unusual for viral and mycoplasmal pneumonia and BAC, and somewhat unusual for lymphoma.

Return

Clinical summary Image 1

Table of Contents