Case: A patient with a lung cavity

Scenario: 47 years old male with a history of alcohol abuse is admitted to the ICU with a week-long fever, cough, hypoxia, and dehydration. Following CXR is obtained. What is your primary concern/diagnosis? 




Answer: Acute necrotizing pneumonia with the formation of a cavity. (See right lower lobe thick walled cavity)

Cavitation seen in infectious diseases is secondary to bacterial toxins and enzymes released by leukocytes, leading to tissue necrosis. The typical radiographic pattern is usually segmental homogenous consolidation and subsequent cavitation, indicating acute necrotizing pneumonia. The cavities are typically thick-walled and may be multiple if the pneumonia is multi-lobar. Differential diagnosis includes neoplasm, post-infarction, fungal disease, or tuberculosis. 

 Bronchoscopic lavage and CT scan may help establish a diagnosis.

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References:

1. Kapania EM, Cavallazzi R. Necrotizing Pneumonia: A Practical Guide for the Clinician. Pathogens. 2024 Nov 10;13(11):984. doi: 10.3390/pathogens13110984. PMID: 39599537; PMCID: PMC11597800.

2. Krutikov M, Rahman A, Tiberi S. Necrotizing pneumonia (aetiology, clinical features and management). Curr Opin Pulm Med. 2019 May;25(3):225-232. doi: 10.1097/MCP.0000000000000571. PMID: 30844921.

3. Chatha N, Fortin D, Bosma KJ. Management of necrotizing pneumonia and pulmonary gangrene: a case series and review of the literature. Can Respir J. 2014 Jul-Aug;21(4):239-45. doi: 10.1155/2014/864159. Epub 2014 May 2. PMID: 24791253; PMCID: PMC4173892.