Pulmonary Abscess With Contiguous Extension to the Chest Wall in an Immunocompetent Young Woman: A Case Report

Lung abscesses are localized necrotizing infections of the pulmonary parenchyma that rarely extend into the chest wall. We report the case of a previously healthy 21-year-old veterinary medicine student who presented with fever and painful left infraclavicular swelling that became more prominent with coughing, despite the absence of significant respiratory symptoms. Laboratory evaluation revealed marked neutrophilic leukocytosis and an elevated C-reactive protein level. Contrast-enhanced chest computed tomography (CT) demonstrated left upper lobe consolidation with a cavitary lesion containing an air-fluid level and extending through the first intercostal space into the anterior chest wall and subpectoral tissues. An extensive microbiological investigation excluded relevant alternative infectious etiologies, although respiratory cultures yielded findings of uncertain clinical significance. Percutaneous drainage was considered but deferred because of the limited drainable fluid component. The patient completed four weeks of intravenous antimicrobial therapy, with progressive clinical, laboratory, and radiological improvement. At the three-month follow-up, chest CT confirmed complete resolution of both the pulmonary and chest wall lesions. This case highlights chest wall swelling as an uncommon presentation of lung abscess and emphasizes the importance of cross-sectional imaging, cautious interpretation of respiratory cultures, and individualized multidisciplinary management.