An 86-year-old male patient with a history of chronic obstructive pulmonary disease and chronic dysphagia presented to the emergency department with shortness of breath. He had recently been diagnosed with aspiration pneumonia and completed a 7-day course of levofloxacin. At follow-up with his primary care physician, he reported ongoing symptoms and had a chest X-ray which showed a persistent left lower lobe consolidation (Fig. 1). On presentation to the emergency department, he was afebrile and pulse oximetry was 99% on room air. Examination revealed decreased breath sounds at the left base. Laboratory evaluation was unremarkable. Point-of-care lung ultrasonography was performed (Fig. 2), and based on ultrasound findings, computed tomography of the chest was obtained (Fig. 3).
Ultrasound showed a hypoechoic, complex fluid collection within a left lung base consolidation, suggestive of a lung abscess (Fig. 2). Computed tomography of the chest confirmed a large parenchymal abscess, measuring 5 × 7 mm, with additional multifocal abscesses (Fig. 3). The patient was started on intravenous piperacillin and tazobactam and admitted to the hospital. This patient’s abscess was presumed to be a polymicrobial infection due to aspiration, which is the most common cause of lung abscesses [1]. He was ultimately discharged on 6 weeks of oral amoxicillin-clavulanate.
Lung ultrasound is an important diagnostic tool in patients with respiratory complaints. It can provide more detail than chest X-ray in evaluating peripheral lung pathology. Lung ultrasound is more accurate than chest X-ray at differentiating consolidation and pleural effusion, and in diagnosing simple or complex effusions [2].
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation 
Print 
