PMC5313435_01
Three days before admission, chest CT showed a mass in the left upper pulmonary lobe without any chest wall abnormalities (arrows).
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Chest computed tomography (CT) obtained at the other hospital showed a mass in the left upper pulmonary lobe without any chest wall abnormalities (Fig. 1).
A palpable, pink erythematous, warm and tender mass measuring 8 cm in size was located on the left anterior chest wall.
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A physical examination revealed a palpable, pink erythematous, warm and tender mass measuring 8 cm in size located close to the sternum overlying the left first to third intercostal spaces (Fig. 2).
A chest X-ray obtained on admission demonstrated a 7x5 cm mass in the left upper lung field.
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A chest X-ray obtained on admission demonstrated a 7x5 cm mass in the left upper lung field (Fig. 3).
Chest contrast-enhanced CT showed a gas-containing lung abscess in the left upper lobe (A) and a chest wall abscess (arrows on A and arrow on B). There is some air in the first sternocostal joint (arrows on A and C) without pleural effusion (D) and the abscess extended between the lung and the chest wall.
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Chest contrast-enhanced CT showed a gas-containing lung abscess in the left upper lobe and a chest wall abscess (Fig. 4).
Surgical debridement of the subcutaneous and intramuscular fluid collection was carried out under local anesthesia.
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Surgical debridement of the subcutaneous and intramuscular fluid collection was carried out under local anesthesia (Fig. 5).
Chest CT (A) after drainage therapy under ultrasonographic guidance. An 8-Fr aspiration catheter was percutaneously inserted into the lung abscess, and odorless pus was drained (B).
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Then, under ultrasonographic guidance, an 8-Fr aspiration catheter (Argyle  Aspiration Catheter; Covidien, Japan) was percutaneously inserted into the lung abscess, and odorless pus was drained (Fig. 6).
After the antimicrobial therapy, chest CT (A, B) and chest radiography (C) showed a remarkable improvement.
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After 16 days of antimicrobial therapy, the catheter was removed because the drainage had become serous and chest CT showed a remarkable improvement (Fig. 7A and B). At a follow-up examination at 1 month after the patient's discharge, she was asymptomatic and demonstrated normal chest radiography findings (Fig. 7C).