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Page 6 / Case 01.03

ANSWER

1. similar to first cxr
2. large homogenous added density occuping most of the left hemi-thorax
3 .large cavity with a mobile air fluid level in the superior aspect
4. small amount of pleural fluid as seen in the lateral decubitus film
5. shift of mediastinum The diagnosis is consistent with a lung abscess

PROGRESS

At this point we decided to continue treatment with antibiotics alone

INVESTIGATIONS

WBC: 7.5, Neut:2.4, Band 1.3, CRP (C reactive protein) 300 mg/l.

A blood culture sent and she was started on clindamycin and cefotaxime intravenously. She gradually improved and became afebrile once again. Nine days later she was a well looking child, but still had markedly decreased breath sounds on left side.

Her lab results at that time included: WBC: 9.2 Neut: 3.7 band :0.1, CRP :32 mg/l. Blood cultures had been negative and clindamycin was discontinued.

BELOW IS HER CHEST RADIOGRAPH


ENLARGE this chest X-ray, top LEFT, RIGHT.

WHAT IS YOUR DIAGNOSIS NOW?



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