🩻 TOACS FCPS Station · Chest X‑ray: Lung Abscess (Left Lower Lobe)
📷 Chest X‑ray (PA view)
🔍 Key radiographic features:
- ✓ Thick‑walled cavity in the left lower lobe
- ✓ Air‑fluid level within the cavity (horizontal interface)
- ✓ Surrounding consolidation / infiltrates
- ✓ Irregular, thick inner wall (contrast with thin‑walled pneumatocele)
- ✓ May have adjacent pleural reaction
📋 Clinical scenario (examiner prompt)
A 5‑year‑old child presents with fever, productive cough, and chest pain for 2 weeks. The cough is sometimes foul‑smelling. He has poor appetite and has lost 1.5 kg over the past month. Chest auscultation reveals dullness and crackles in the left lower zone. The chest X‑ray (PA view) shows a thick‑walled cavity with an air‑fluid level in the left lower lobe.
🧑⚕️ Examiner tasks · TOACS
1. Identify the diagnosis from the X‑ray and clinical context.
2. Describe the pathology (necrotizing infection with cavity formation).
3. Describe the X‑ray findings (thick-walled cavity, air-fluid level, location).
4. Discuss management (antibiotics, drainage, surgery).
🎯 Expected answers (for examiners)
- • Diagnosis: Pulmonary abscess (left lower lobe)
- • Pathology: Necrotizing infection with cavity formation; often anaerobic/aspiration
- • X‑ray: Thick-walled cavity with air-fluid level in LLL
- • Management: IV clindamycin or ampicillin-sulbactam (3-4 weeks total); CT-guided drainage if large or fails antibiotics; lobectomy if complicated
⚡ Quick FCPS‑style MCQ
The most likely pathogen in a child with a foul‑smelling lung abscess is:
A. Streptococcus pneumoniae B. Oral anaerobes (Fusobacterium, Peptostreptococcus) C. Staphylococcus aureus D. Mycobacterium tuberculosis📌 Topic summary ·
Necrotizing infection with cavity + air-fluid level
Oral anaerobes (Fusobacterium, Peptostreptococcus), S. aureus, S. pneumoniae
Clindamycin or ampicillin-sulbactam IV
3-4 weeks total (2-3 weeks IV, then oral)
CT-guided for large (>4-6 cm) or failure of antibiotics
Lobectomy for massive hemoptysis, bronchopleural fistula, failure
| Intervention | Indication |
|---|---|
| IV antibiotics | All patients (2-3 weeks, then oral for total 3-4 weeks) |
| Percutaneous CT-guided drainage | Large abscess (>4-6 cm), failure of antibiotics after 7-10 days |
| Surgical lobectomy | Failure of antibiotics + drainage, massive hemoptysis, bronchopleural fistula |