PMC6476028_01
(a) Initial chest CT with newly identified lymphadenopathy. (b) Chest CT 10 days after EBUS with new subcarinal mass. (c) Chest CT 26 days after EBUS with right lower lobe pulmonary abscess. (d) Chest CT following a 6-week course of IV and oral antibiotic therapy (mediastinal and lung windows).
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Her dry cough had persisted for 4 months, and computed-tomography (CT) of the chest demonstrated right lower lobe clusters of noncalcified, solid nodules, largest measuring 10 x 15 mm, with an enlarged subcarinal lymph node (LN) measuring 1.4 x 2.8 cm (Figure 1). Initial laboratory work demonstrated a mild leukocytosis with left shift (12.5 x 109/L, 76.9% neutrophils), and CT chest was significant for a large subcarinal mass measuring 5.5 x 2.6 cm causing mass effect on adjacent vessels and esophagus (Figure 1). Two weeks later, the patient continued to have a cough and repeat imaging showed a new 7.7 x 3.9 x 8.0 cm irregular, heterogeneous, air-containing mass in the superior medial right lower lobe concerning a lung abscess (Figure 1). Follow-up imaging after completion of antibiotics demonstrated near-resolution of the abscess (Figure 1).