These are actual cases to –Stimulate your reading –Test your knowledge of the material Look for the sound icon

25 year old male 2 to 3 weeks of gradually worsening productive cough minimal improvement with Levofloxacin went to ER nonsmoker PMHx unremarkable Physical Exam: VSS, no adenopathy. Resp – coarse breath sounds right lung, no clubbing. Cardiac, neurologic, abdominal exam unremarkable. Bloodwork – leukocytosis and mild bandemia

Q1: Interpret the CXR. Answer (Q1)

Q2: Based on the clinical and radiographic information provided, what are the diagnostic possibilities and your most likely diagnosis? Answer next slide

Lung Cavity Lung AbscessCavitating Malignancy Vasculitis Mets to the lung Septic emboli Usually seen with multiple cavities Answer (Q2) Certain gram positive cocci, gram negative bacilli, anaerobes TB, fungus Squamous cell Adenocarcinoma

Q3: How would you manage this patient? Answer (Q3)

After 3 weeks of antibiotics, the patient has minimal symptomatic improvement. CXR – no change Q4: How would you manage the patient lacking symptomatic or radiographic improvement? Answer on next slide