Sunday, 11 November 2012

A 13-year-old girl with a history of 2 days of cough and fever has the chest x-ray shown here. The most appropriate treatment is

a. N-acetylcysteine
b. Prolonged course of ampicillin combined with a ß-lactamase inhibitor
c. Lobectomy
d. Postural drainage
e. Thoracentesis and chest tube

The answer is b. The x-ray reveals a lung abscess involving the right upper lobe characterized by the round density, the air-fluid vel, and the opaque rim. Lung abscesses are usually caused by anaerobic bacteria such as bacteroides, fusobacteria, and anaerobic streptococci, and on occasion by Staphylococcus aureus and Klebsiella. The organisms were previously sensitive to penicillin, but some anaerobic organisms (especially bacteroides) are now resistant due to ß-lactam production. Lung abscesses frequently respond surprisingly well to treatment with antibiotics alone.


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