Chest X-ray mass in a patient with lung cancer!

A 69-year-old gentleman with extensive small cell lung carcinoma was admitted to hospital for further treatment of a lung abscess detected after a third cycle of chemotherapy. He had a 4-week history of a productive cough and recent rigours which had been treated with antibiotics without improvement. Findings included decreased air entry with localized wheeze in the left upper zone, a temperature of 38.2°C, leukocytosis with neutrophilia and a rounded mass on chest X-ray (Figure 1). Computed tomography (CT) of the thorax demonstrated a fluid-filled cavity in the left upper lobe in keeping with a pulmonary abscess (Figure 2). A CT guided drain was inserted into the abscess and green coloured fluid was immediately drained (Figure 3). Microbiological analysis revealed Escherichia coli and appropriate antibiotics were continued. A total of 300 ml was drained and a chest X-ray 6 days later demonstrated almost complete resolution of the abscess (Figure 4). The patient was referred back to the oncology service on oral antibiotics.