Correct!
2. The lesion is most consistent with a pulmonary abscess


The appearance of the lesion is not inconsistent with a primary lung neoplasm, and as discussed above, bronchogenic carcinoma is rare in a patient of this age group. One of the more common primary neoplasms in patients of this age- carcinoid tumor- usually does not present in this fashion (see the June 2012 Case of the Month). Primary pulmonary lymphoma could present as an isolated lung mass in a patient of this age, but is most commonly encountered in severely immunocompromised patients. Primary pulmonary lymphoma can develop in non-immunocompromised patients, but one particular finding on the thoracic CT argues against lymphoma- this feature is discussed in the next section. The lesion is unlikely to represent a thoracic manifestation of a subdiaphragmatic process- the most common manner in which subdiaphragmatic processes present in the thorax is with pleural effusion, which is absent in this patient. A post-traumatic etiology is also unlikely, as there is no mention of recent trauma in the history provided and no other evidence of trauma is seen on the CT. Finally, the margins of the lesion suggest a primary origin from lung, not from the chest wall or pleura. Also the cavitation seen within the lesion is characteristic of a lung lesion, not a pleural lesion. Among the choices provided, a mass-like lesion with central cavitation in a young patient with the history provided is most suggestive of a pulmonary abscess.


The patient was treated with antibiotics and his symptoms of hemoptysis, cough, fever, and chest pain resolved. Upon pointed questioning, the patient admitted to several prior similar episodes in the past, treated similarly, with resolution.


Which of the following represents the most appropriate next step in management at this point?

  1. Thoracic surgery
  2. Catheter angiography of the bronchial circulation
  3. Thoracic MRI and MR angiography (MRA)
  4. Thoracic CT angiography (CTA)
  5. 18FDG-PET scanning

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