Respi case 02

Case courtesy of Dr Suzy

56 y/o previously works at electronic company, exposure to aluminium U/L childhood BA, initially presented to ED on 20/4/19, complaining SOB, cough for 5/7 and fever for 5 days. No history of sick contact/TB contact, no constitutional symptoms. Upon arrival to ED, pt tachypneic and hypoxic.


Description
CECT thorax, abdomen and pelvis

Findings:

Thorax:
Large lung abscess noted occupying the right middle lobe measuring
14.2cm(AP) x 12.1cm(CC) x 9.2cm(W).Minimal enhancement of the abscess wall seen. Air -fluid level, multiple internal septations and small air pockets noted within the abscess.
The lung abscess abutts the pericardium, however there is no associated pericardial collection seen.
Compressive segmental collapse of the right upper lobe lung segment seen.
Proximal part of the right middle lobe bronchus, right upper and lower lobe bronchi are patent.
Patch of collapse/consolidation associated with bronchiectasis seen at apical region of the right upper lobe.
Bronchiectatic changes associated with focal atelectasis,linear fibrosis and ground glass opacities are also seen at the left lingular and both lung bases.
Subpleural bullae seen at apical segment of the right lower lobe.
No pleural collection.
Trachea, main bronchi, segmental and its subsegmental branches are normal.
Subcentimeter mediastinal nodes seen at station 2R, 4R and 4L.
Thyroid gland is normal.

Abdomen/pelvis:
Liver, gall bladder, spleen, pancreas and adrenals are normal.
Few,small renal cysts seen on both sides.
Bowel loops appear grossly normal.
No obvious bowel-related mass or abnormal bowel wall thickening.
Urinary bladder is underfilled with Folley”s catheter in situ.
Prostate and seminal vesicles appear normal.
No significant abdominopelvic lymphadenopathy.
No ascites.

Minimal degenerative spine changes. No suspicious bony lesion.

Impression:
Large right lung abscess with patchy areas of collapse/consolidation and underlying bronchiectasis.
Bilateral simple renal cysts

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