PMC6529402_01
Chest X Ray from admission showing hyperinflation and a dense opacity on the superior segment of the right lower lobe suggesting pneumonia.
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Initial chest x-ray showed a moderate dense opacity in the superior segment of the right lower lobe suggestive of pneumonia (Fig. 1).
Chest CT scan done one year before admission shows small consolidation in the lateral aspect of the superior segment of the right lower lobe.
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One year prior to admission, he had a CT scan of the chest (Fig. 2) for routine investigation of a pulmonary nodule.
A. CT scan on admission demonstrating large area of consolidation involving the right upper lobe extending to the suprahilar region containing multiple low-density foci which may reflect multiple cavitary areas. This was suggestive of severe necrotizing pneumonia. B. CT scan on admission of the superior segment of the right lower lobe demonstrating a posterior cavitary lesion that is thick-walled and irregularly marginated measuring 4.6 cm by 3.4 cm by 4.9 cm. C. CT scan on admission revealing smaller cavitary type foci seen inferomedially in the right lower lobe along with areas of consolidation and dilated airways likely representing bronchiectatic changes.
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On the first day of the current hospitalization, a chest CT obtained for accurate assessment of his pulmonary disease showed extensive consolidation of the superior segment of right lower lobe extending into the right upper lobe with multiple cavitary type foci concerning for necrotizing pneumonia along with a cavitary lesion in the superior segment of the right lower lobe measuring 4.6 x 3.4 x 4.9 cm (Fig. 3A-C), seen on the previous chest CT done the year prior, but now increased in size.