A 40-year-old woman with lung cavitation
- Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
- Sushil K Ahlawat, 55, Sector 24-A, Chandigarh- 160 023, India
- Accepted 2 March 1999
A 40-year-old woman presented to the emergency room with intermittent fever, cough, haemoptysis and dyspnoea for one week. She also had a history of episodic breathlessness with wheezing for the last 5 years. She did not drink alcohol or smoke tobacco, denied intravenous drug abuse or use of steroids. On physical examination, the patient was febrile (temperature, 38.5°C), tachypnoeic and tachycardic. Blood pressure was 150/90 mmHg. Examination of lungs revealed bilateral coarse crackles and rhonchi. The rest of the systemic examination including cardiovascular system was normal. Serial chest X-rays are shown in figures 1 to 3.
Chest X-ray (PA view) at presentation
Chest X-ray (lateral view), one week later
Questions
- 1
- What are the findings on serial chest X-ray ?
- 2
- What is the differential diagnosis ?
Answers
QUESTION 1
The first chest X-ray (figure 1), which was taken at presentation, shows bilateral non-homogenous opacities and a thick walled cavity in the left mid-zone with surrounding consolidation. The second X-ray (figure 2), taken a week later, shows bilateral, multiple lung cavitation with air–fluid levels. Pulmonary cavities in both upper and lower lobes are also seen on lateral view (figure 3). The chest X-ray in figure 4, taken approximately 4 weeks after starting treatment, shows significant resolution of pulmonary lesions with antibiotic therapy.
Chest X-ray (PA view), one week later
Chest X-ray (PA view), 4 weeks …
