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Case 114 

Case 114
Chapter:
Case 114
Author(s):

Ellen Chung

DOI:
10.1093/med/9780199758968.003.0114
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date: 19 November 2019

18-month-old with acute shortness of breath 3 days ago, now clinically improved.

PA and lateral chest radiographs demonstrate fluffy bilateral opacities in the right middle lobe and lingula containing air-filled cavities (arrowheads).

The differential diagnosis for air-filled cavities also includes pulmonary abscess and cavitary pulmonary necrosis. Clinical status helps to differentiate necrosis and abscess, in which the patient is sick, from pneumatocele, in which the patient is clinically improving. Other clues indicating severe infection, such as near white-out of the lung and large nondependent pleural fluid collection, would suggest necrotizing pneumonia or abscess. On CT, abscesses tend to have thick, irregular walls, while pneumatoceles have smooth, thin walls. Abscesses would be found in enhancing consolidated lung, while cavitary necrosis is seen in lung tissue that is nonenhancing. Differentiating the abscess from cavitary necrosis is not clinically important as both do well in the long term with drainage of the empyema and intravenous antibiotic therapy....

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