When the Missing Link Was a Drink: Missed Diagnosis of a Lung Mass Due to Limited History

A 24-year-old male patient presented with a two-month history of productive cough and hemoptysis. Chest imaging revealed a 3.2 cm cavitating lesion in the right lower lobe, initially suspected to be either an inflammatory mass, neoplasm, or aspergilloma. He underwent video-assisted thoracoscopy with a right lower lobectomy which revealed a 4.5 cm cavitary mass and lymphoid hyperplasia, consistent with aspiration lung abscess. Post-operatively, the patient experienced a persistent pneumothorax requiring extended monitoring and follow-up. Subsequently, the patient disclosed a history of recurrent binge drinking with episodes of unconsciousness, establishing the etiology as aspiration-related. The delayed identification of the alcohol use history contributed to a missed diagnosis of aspiration lung abscess. As a result, the patient was not treated with intravenous antibiotics, which might have obviated the need for a lobectomy and its attendant surgical risk. This report underscores the critical importance of allocating sufficient time and effort to obtain a thorough clinical history.