Pulmonary abscess with atypical topography - computed tomography assessment before and after treatment

We present a clinical case of a patient with neurological sequelae, dementia, gastrostomy and tracheostomy with a metal canula, who developed a lung abscess in an atypical topography, in the anterior segment of the left upper lobe, being attended to in the emergency department.

A 79-year-old man who was bedridden and with neurological sequelae resulting from a hemorrhagic stroke, with gastrostomy and tracheostomy with a metal canula, was attended for daily fever and increased secretion trough the canula, and a diagnosis of bronchoaspiration pneumonia was made. The chest X-ray was unremarkable with an evaluation impaired by the patient's posture. The chest CT showed a characteristic image of an abscess in the topography of the anterior segment of the upper lobe. Improvement in the patient`s clinical condition was accompanied by an improvement in the CT imaging results. And the other exams carried out did not show any other associated lung disease.

Chest X-ray is still the initial method for studying infectious lung lesions, and CT is indicated in cases where the appearance of the lesion is not well defined, if doubts persist, whether the patient is immunosuppressed or oncological. CT can provide better definition of abscess imaging findings and is particularly useful for visualizing cavities not well delineated by X-ray, especially when a malignant neoplastic tumor lesion is suspected or when there is an associated pleural collection.