Pleural thickening mimicking with lung abscess and loculated

hydropneumothorax: A case report

Introduction
Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities.
Ruptured of lung abscess can be differential diagnosed with hidropneumothorax and is very
difficult to differentiate. Surgery is considered if little chances for conservative healing. A
case of a 52 years old female who undergo surgery for diagnostic and terapeutic was
presented.

Case Report
A 52 years old female, experienced left chest pain for 3 weeks before admission, coughing
with yellow sputum, caries dentis, history of DM since 5 years ago and no history of TB.
First chest X ray examination showed homogen opacity in superior and middle lobes of left
lung and became air fluid level imaging after a week. Chest CT scan with contrast presented
the imaging tend to left lung abscess differential diagnosed with loculated
hydropneumothorax. Spirometry result was mild restriction and bronchoscopy showed totally
compression stenosis in lingula and partially in upper division. Microbiology test find E.
Colli in sputum culture and sentive to meropenem, while we did not get sample from
diagnostic thoracosintesis. The patient was given antibiotic for 10 days and was refered to
cardiothoracic surgery department. Thoracotomi exploration was performed and empty space
in superior and thickening of pleural that can be seen led to decortication.

Discussion
Lung abscess is the process in parenquime while hydropneumothorax is in pleural cavity. It
leads to different treatment approach. Antibiotics are used in both of abscess and its
complication such as ruptured. The evaluation of antibiotics by normally radiology after 2
months of the consumption although some studies report lack healing if abscess size is
greater than 6 cm.

Keywords: lung abscess, hydrpnemothorax, pleural thickening