CXR Case 036

A 19 year old man is found collapsed at a friends house and brought to ED. His mates say he has been drinking alcohol heavily but deny other drug use.

BP 92/53, warm and dilated peripherally, Temp 37.7C, responds to voice.

click images to enlarge

Describe and interpret this CXR and CT chest


CXR Interpretation:
There is diffuse air space shadowing in the right mid zone with an area of central lucency and air fluid level.
*A left nipple ring is noted
The rest of lung parenchyma and pleura are normal

CT Interpretation:
CT demonstrates a thick walled cavity in the apical segment of the right lower lobe.
*There is an air fluid level with some surrounding consolidation


The most likely diagnosis is aspiration from reduced conscious level causing a lung abscess and systemic sepsis.


The anatomical location of an abscess caused by aspiration relates to the position an individual was lying / sitting in when aspiration occurs – with the apical segment of the lower lobe often being the first stop for aspirated material when lying supine.


Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar | ICIS Course ANZ

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