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Lung abscess — SCE Respiratory MCQ

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ModerateRespiratory InfectionsLung abscessSCE Respiratory

A 67-year-old man has persistent fever and cough 5 days after starting antibiotics for right lower-lobe pneumonia. Repeat CXR shows a new air-fluid level within a thick-walled cavity in the same lobe. He has foul sputum and poor dentition. What is the most likely diagnosis?

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Correct answer: E — Lung abscess due to aspiration

A cavitating air-fluid level with foul sputum and aspiration risk factors is typical of lung abscess. PE and organising pneumonia do not usually cause a thick-walled cavity with putrid sputum. The teaching point is to obtain microbiology and treat with prolonged antibiotics covering anaerobes, while considering obstruction if recovery is poor.

Reference: NICE NG250; BTS CAP Guideline