Pulmonary abscess as a complication of COVID-19 associated pneumonia: a clinical case

The article describes a case of polysegmental destructive viral-bacterial pneumonia complicated with acute pulmonary abscess, pleural empyema, and pneumopleurofibrosis in a 50-year-old female patient infected with the SARS-CoV-2 virus. The first clinical, laboratory and radiological signs of purulent-necrotic inflammation appeared only 20 days after receiving a positive RT-PCR test result with a nasopharyngeal swab. A month later, an emerging abscess in the lower lobe of the right lung was diagnosed. Subsequently, it spontaneously drained into the pleural cavity.Coagulopathy with the formation of microthrombi in small pulmonary vessels is one of the causative factors of lung abscess in patients infected with the SARS-CoV-2 virus.

Legionella pulmonary abscess and pleural space infection in an immunocompetent patient

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her Legionella urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. CT imaging revealed interval development of a loculated complicated parapneumonic effusion. Successful treatment required chest tube drainage assisted by fibrinolytic therapy. This case highlights the importance of considering Legionella in patients with pulmonary abscess, demonstrates an approach to a patient with a non-resolving pneumonia and illustrates the management of parapneumonic effusions.

Differential X-ray diagnosis of pseudotuberculous scenario of pulmonary abscess with tuberculous cavities

Background. Recent decades in Ukraine have been characterized by a significant increase in the number of tuberculosis patients, often with forming cavities of destruction. X-ray diagnosis of lung cavitary lesions is one of the current issues of modern pulmonology and thoracic surgery. Pulmonary abscesses resemble other diseases with destruction and cavities substantiating the need for differential diagnosis with tuberculosis. Purpose – specifying particular scenarios of X-ray presentation of lung abscess and determining the capability of differential diagnosis of pseudotuberculosis with cavities of tuberculosis etiology. Materials and methods. The paper deals with the analysis of X-ray examination of thoracic viscera provided for 252 patients with lung abscess, aged 18 and up to 78. X-ray radiography in two projections, linear and computed tomography (56 patients involved) were performed. All patients underwent a study over time. Results. Almost in most lung abscess cases, there is a need for differential diagnosis with a range of medical entities. The obtained data have made it possible to suggest a classification of X-ray scenarios of lung abscess. The scenarios of X-ray presentation of acute pulmonary abscess are typical and atypical, among those: cystoid, pseudotuberculous, affected 38 patients (15 %), and pulmonary-pleural. The peculiarities of X-ray presentation of pseudotuberculous scenario along with the differences and signs allowing to make an accurate diagnosis have been specified. Conclusions. X-ray study remains an essential in diagnosing purulent-destructive diseases. Being familiar with the scenarios mentioned above and pseudotuberculous one, in particular, will make it possible to significantly improve diagnosis as well as differential diagnosis of pulmonary abscess.