In adults, round pneumonias may be due to infections like Q fever, legionella micdadei, streptococcus pneumoniae, hemophilus influenzae, or rickettsia typhi, and noninfectious causes like bronchogenic carcinoma, round atelectasis, organizing pneumonia, bronchopulmonary sequestration, granulomatosis with polyangiitis, septic pulmonary emboli, rheumatoid nodules or sarcoidosis. They are rarely seen in adults because the development of the pores of Kohn and canals of Lambert is completed by the age of eight.1,2 A 70 year-old woman exsmoker with coronary heart disease and diabetes was admitted with high fever, purulent sputum, dyspnea and anorexia. She was tachypneic, tachycardic and required a FiO2 of 50% to ensure adequate oxygenation. Inflammatory markers were markedly elevated – leucocytes, neutrophils, procalcitonin. A presumptive diagnosis of community acquired pneumonia was made, CURB65: 4/5.
Round left upper lobe infiltrate with clear borders (arrows) is shown in Fig. A. The CT identifies a homogeneous mass-like infiltrate with some air bronchogram (short arrows) and no distorsion of the pulmonary vessels (long arrows) (Figs. B, C). On the day of discharge, the “mass” is vanished (Fig. D).
The blood cultures were positive for steptococcus pneumoniae. The response to antibiotics was adequate and the patient was discharged ten days later. The dissapearance of the infiltrate may help avoid an unneccessary bronchoscopy.
