• 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 Abscess Cavitating Malignancy

VasculitisMets 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