Case 211 -- Cavitary Lesion in the Right Upper Lung Lobe

Contributed by Douglas R. Johnson, MD, A. William Pasculle, ScD and John Sheaffer, MS
Published on line in October 1999


This 39 year-old female presented to an outside institution with a 2 week history of chills and non-productive cough. She also reported episodic "bronchitis" once or twice a year, and a smoking history of 1 to 2 packs of cigarettes per day. The patient received a course of Amoxicillin with apparent resolution of symptoms; however, a routine chest radiograph revealed a 3 cm cavitary lesion in the right upper lung lobe ( IMAGE 1 ). She was subsequently referred to a pulmonary medicine specialist for further evaluation. The patient later reported that she had resided in Arizona for a ten years where she worked as an apprentice electrician in a "dusty desert environment." Serologic studies for Coccidioides were negative, however; and multiple sputum cultures and a PPD were also negative. A lung CT scan confirmed the presence of the right upper lobe cavity and showed adjacent bronchial distortion and fibrosis, raising the possibility of a cavitating neoplastic process. Several additional small nodules identified in the left upper lung lobe were interpreted as typical for the appearance of a mycobacterial infection ( IMAGE 2, IMAGE 3, and IMAGE 4 ).



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