Chronic Productive Cough

Bronchoscopy may be performed if malignancy is suspected.1-4 Antibiotic therapy is the first-line treatment for a lung abscess, followed by surgery in patients who do not respond to medical management or in the presence of malignancy. Treatment duration should be based on response to therapy.1,3 Factors that may predict a worse prognosis include hemoglobin level of less than 10 g per dL (100 g per L); larger abscess; and infection with Pseudomonas aeruginosa, Staphylococcus aureus, or Klebsiella pneumoniae.5 Aspergilloma has a wide variety of clinical presentations, including cough, weight loss, fever, and hemoptysis, although it may be asymptomatic. Chest CT with intravenous contrast media enhances the pleural surface, delineating the pleural fluid loculi.8,9 Summary Table Condition Characteristics Aspergilloma Varied clinical presentation similar to lung abscess, including cough, weight loss, fever, and hemoptysis; may be asymptomatic; CT reveals soft tissue mass in the lung, usually the upper lobe, separated from cavity wall by airspace (air crescent sign) Bronchiectasis Chronic, productive cough sometimes accompanied by hemoptysis; CT shows increased airway diameter, lack of peripheral airway tapering, airway constrictions, and ballooned cysts toward the end of the bronchus Localized empyema Symptoms similar to lung abscess; however, CT helps differentiate the conditions Lung abscess Localized lung parenchymal necrosis; symptoms include fever, productive cough, foul-smelling or bad-tasting sputum, night sweats, hemoptysis; radiography shows cavitary lesion with fluid level CT = computed tomography.