Lung abscess diagnosed by ultrasound

Article information

Clin Exp Emerg Med. 2022;9(1):70-71

Publication date (electronic) : 2022 March 31

doi : https://doi.org/10.15441/ceem.21.069

Anne Huyler^,1, David Mackenzie^1,2, Christina N. Wilson^1,2

¹Department of Emergency Medicine, Maine Medical Center, Portland, ME, USA

²Department of Emergency Medicine, Tufts University School of Medicine, Boston, MA, USA

Correspondence to: Anne Huyler Department of Emergency Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA E-mail: ahuyler@mmc.org

Received 2021 April 6; Accepted 2021 May 14.

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).

Fig. 1.

Posteroanterior chest X-ray with an opacification within the left lung base.

Fig. 2.

Lung ultrasound of the left lung base showing a well-circumscribed, hypoechoic lung abscess (asterisk) within consolidated lung with a surrounding pleural effusion (arrow).

Fig. 3.

Axial view of computed tomography of the lung demonstrating the lung abscess (asterisk) within consolidated lung.

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].