A 74 yo lady is sent in to ED from cardiology clinic with dyspnoea, pleuritic chest pain and fevers. She has a PPM and type II diabetes
Describe and interpret this Images
There is a left pleural effusion, left basal increased airspace opacification with central lucency and an air fluid level.
*There are multiple different size < 1cm, rounded lesions throughout both lung fields, some with minor cavitation.
Lateral CXR Interpretation:
Lateral X-ray demonstrates a cavity with an air fluid level and associated pleural effusion with loculated fluid superior to the cavity.
CT Chest Interpretation:
CT confirms the presence of a large thick walled fluid containing cavity in the left lower lobe with associated pleural thickening.
*There are small patches of consolidation in the lingula and on the right side.
This lady has septic emboli causing lung abscess and pleural infection.
*The source of the infection is presumed to be the pacing leads. Staphylococcus aureus was cultured from blood.
One of the major concerns in this case was if the lung abscess was directly communicating with the pleural cavity.
Drainage of the pleura is indicated, drainage of the abscess (with subsequent bronchopleural fistula formation) is not indicated!