CTICasesRecurrent Necrotizing Pneumonia from Chronic Aspiration
Imaging findings
Over several months of serial imaging, a patient develops recurrent episodes of focal necrotizing pneumonia and abscess formation, right-side predominant, beginning as a small area of consolidation in the right middle lobe that progressively enlarges and liquefies, resolves partially with antibiotic treatment, and then recurs as new abscesses in different right lung regions, including the right lower lobe, with associated pleural fluid and a split-pleura sign on one study; no organism was ever cultured despite repeated treatment.
Key takeaways
The recurring, right-side-predominant pattern of necrotizing pneumonia and abscess formation over multiple months, together with subtle findings suggestive of small-airways aspiration bronchitis and bronchiolitis and a slightly abnormal, fluid-containing esophagus on some studies, points to chronic recurrent aspiration as the underlying cause even without a clear structural explanation or positive cultures, illustrating that aspiration should remain a leading consideration for recurrent, side-predominant necrotizing pneumonia of unclear etiology.
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