CTICasesPrimary Pulmonary Adenocarcinoma Mimicking Lung Abscess
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Imaging findings
Initial chest CT demonstrates a thick-walled cavity with an air-fluid level, adjacent atelectasis, and pleural thickening, which closely mimics an infectious lung abscess. Follow-up imaging reveals persistent cavitary disease, worsening left hilar lymphadenopathy, encasement of the left inferior pulmonary vein, and pleural invasion, along with metastatic tree-in-bud and centrilobular nodules in the contralateral lung.
Key takeaways
Primary lung adenocarcinoma can present as a thick-walled cavitary lesion with an air-fluid level, closely mimicking an infectious pulmonary abscess. A high index of suspicion and biopsy should be pursued for any 'abscess' that fails to regress with appropriate antibiotic therapy, especially when there is progressive lymphadenopathy, vascular encasement, or contralateral aerogenous tumor spread manifesting as centrilobular or tree-in-bud nodules.
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