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.
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Describe and interpret this CXR and CT chest
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 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.