46-year-old chronic smoker with bullous emphysema presents with fever and cough for the last 4 days. Diagnosis: 1. Hydropneumothorax 2. Infected bulla 3. Lung abscess

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infected bulla

hydropneumothorax

infected bulla could be most probable diagnosis.as the cp angle is not obliterated may be hydropneumo thorax secondly.needs a CT chest

The shadow is less dense to call a fluid. Though it gives an impression of a fluid level but a possibility of collapse consolidation should be considered

as of history and x ray findings it's infected bulla most likely, obtain culture as mrsa and pseudomonas are most common pathogens., if possible get a CT you have not mentioned about count??

you have to rule out loculated or not
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infected bulla

most likely it is infected bulla ,as pt is not dyspneic, hydropneumothoax is unlikely. second there is no cavity wall visible lung abcess unlikely.advice ,Sp afb,sp c/s pyogenic and CT thorax for diagnosis.

Lculated hydropneumothorax.

infected bulla

infected bulla

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Diseases Related to Discussion

Pneumothorax
Lung Abscess