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Page 6 / Case 01/01


The radiologist commented on pneumonia of the left lung and right upper lobe with pleural fluid and a small pneumothorax on the left. There were lucent areas developing, particularly in the left mid lung field, but also small lucencies in the left lower lung fields, and a lucency in the right upper lung field.

ARE THERE ANY OTHER INVESTIGATIONS WHICH MIGHT BE HELPFUL?


The team elected to do a CT scan.
We have selected four of the images for you to examine.

ENLARGE this CT SCAN (a)

ENLARGE this CT SCAN (b)

ENLARGE this CT SCAN (c)

ENLARGE this CT SCAN (d)

WHAT DO YOU SEE?


There is evidence of left destructive pneumonia with associated left pleural effusion.
There is destructive pneumonia of the right upper lobe area as well.
Cavitary right upper lobe lesion, thick-walled, with no clear air-fluid level.
Left lung destruction more extensive.
Left lower lung multiloculated cavitary process.

The patient stabilized clinically without further intervention.

He was finally diagnosed as having Streptococcus pneumoniae bacteremia / sepsis / pneumonia / empyema with a further complication of necrotizing pneumonia.

By day 5, he was on room air continuously.

By the end of the first week, beginning of second week, he was feeding well and was playful.

By day 14, the chest tube was out.

By day 19, he defervesced.

By day 21, the RR was consistently in the low 40s.

He was sent home to complete a total of 6 weeks IV antibiotic therapy.

He has had an extensive immunological work-up to rule out an immunodeficiency that has been negative thus far. Immunoglobulin levels, complement levels, CH50, AH50, T & B cell enumeration and proliferation, and Diphtheria / Tetanus antibody titres were all normal. The only tests pending are IgE level, neutrophil function studies and a HIV test. He never had any neutropenia, lymphopenia, or eosinophilia.


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