Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 126: A 60-Year-Old with Fever, Purulent Sputum, and Chest Pain
Dec 26, 2024
A 60-year-old man's acute respiratory symptoms lead to an intriguing discussion on lung abscesses linked to chronic alcohol use and dental health. The hosts delve into breath sounds and imaging findings that aid in diagnosis. They explore treatment strategies, highlighting the complications of managing anaerobic infections and the limited effectiveness of standard antibiotics. The episode emphasizes the significant role of patient factors, like oral hygiene, in determining therapy outcomes.
AI Snips
Chapters
Books
Transcript
Episode notes
Presentation Of The Case
- A 60-year-old man with alcohol use presented after 10 days of fever, purulent sputum, and right pleuritic chest pain.
- He appeared cachectic, hypoxic, and had poor dentition with cavernous breath sounds on exam.
Meaning Of Cavernous Breath Sounds
- Cavernous (amphoric) breath sounds reflect a large non-functional airspace near the chest wall.
- These sounds occur in lung abscesses, large blebs, cysts, or extensive bronchiectasis.
CT Findings Indicate Lung Abscess
- Chest CT showed a 7 cm cavity in the posterior right upper lobe with an air-fluid level and adjacent pleural thickening.
- Scattered right lower lobe consolidation and no pleural effusion suggested a primary lung abscess rather than empyema.
