Question:
A 65-year-old male patient, a known T2DM with poor glycemic control and chronic smoker, presented with fever and foul-smelling cough. Chest X-ray was taken. Which of the following statements regarding the CXR is true?
A 65-year-old male patient, a known T2DM with poor glycemic control and chronic smoker, presented with fever and foul-smelling cough. Chest X-ray was taken. Which of the following statements regarding the CXR is true?
Show Hint
Cavitary Lung Lesions Key Identifiers:
- Lung Abscess: Anaerobes, foul sputum, straight horizontal air-fluid level.
- Aspergilloma: Fungal ball, air crescent sign (Monod sign), shifts with position.
- Tuberculosis: Apical thin-walled cavities, chronic cough, weight loss.
- Squamous Cell Carcinoma: Thick, irregular-walled cavity.
- Lung Abscess: Anaerobes, foul sputum, straight horizontal air-fluid level.
- Aspergilloma: Fungal ball, air crescent sign (Monod sign), shifts with position.
- Tuberculosis: Apical thin-walled cavities, chronic cough, weight loss.
- Squamous Cell Carcinoma: Thick, irregular-walled cavity.
Updated On: Sep 3, 2026
- Aspergilloma
- Lung abscess
- Lung consolidation
- Fibrosis
Show Solution
Verified By Collegedunia
The Correct Option is B
Solution and Explanation
Concept:
The combination of specific clinical symptoms (fever, foul-smelling sputum) in a high-risk patient (diabetic, smoker) combined with a classic cavitary lesion on imaging is highly diagnostic of a specific pulmonary infection.
Explanation:
• The patient has significant risk factors for aspiration and impaired immunity (poorly controlled T2DM, chronic smoking).
• The presence of a foul-smelling, putrid cough is the clinical hallmark of an anaerobic pulmonary infection, usually resulting from aspiration of oropharyngeal flora.
• When anaerobic bacteria multiply within the lung parenchyma, they cause liquefactive tissue necrosis, resulting in a thick-walled cavity filled with purulent fluid and gas.
• On a chest X-ray, this manifests as a cavitary lesion containing a distinct, horizontal air-fluid level. This is the radiographic pathognomonic sign of a Lung Abscess (Option B).
• An Aspergilloma (Option A) resides in a pre-existing cavity and shows the Monod (air crescent) sign, not a horizontal air-fluid level, and it does not typically present with acute fever and foul-smelling sputum.
• Simple consolidation (Option C) (like in lobar pneumonia) appears as a uniform radiopacity with air bronchograms, lacking cavitation or fluid levels.
• Fibrosis (Option D) presents as reticular opacities and volume loss, completely inconsistent with acute fever and putrid sputum.
Final Answer:
The clinical triad of aspiration risk, foul-smelling sputum, and fever perfectly correlates with the classic air-fluid level cavitary lesion of a lung abscess on CXR.
The combination of specific clinical symptoms (fever, foul-smelling sputum) in a high-risk patient (diabetic, smoker) combined with a classic cavitary lesion on imaging is highly diagnostic of a specific pulmonary infection.
Explanation:
• The patient has significant risk factors for aspiration and impaired immunity (poorly controlled T2DM, chronic smoking).
• The presence of a foul-smelling, putrid cough is the clinical hallmark of an anaerobic pulmonary infection, usually resulting from aspiration of oropharyngeal flora.
• When anaerobic bacteria multiply within the lung parenchyma, they cause liquefactive tissue necrosis, resulting in a thick-walled cavity filled with purulent fluid and gas.
• On a chest X-ray, this manifests as a cavitary lesion containing a distinct, horizontal air-fluid level. This is the radiographic pathognomonic sign of a Lung Abscess (Option B).
• An Aspergilloma (Option A) resides in a pre-existing cavity and shows the Monod (air crescent) sign, not a horizontal air-fluid level, and it does not typically present with acute fever and foul-smelling sputum.
• Simple consolidation (Option C) (like in lobar pneumonia) appears as a uniform radiopacity with air bronchograms, lacking cavitation or fluid levels.
• Fibrosis (Option D) presents as reticular opacities and volume loss, completely inconsistent with acute fever and putrid sputum.
Final Answer:
The clinical triad of aspiration risk, foul-smelling sputum, and fever perfectly correlates with the classic air-fluid level cavitary lesion of a lung abscess on CXR.
Was this answer helpful?
0
0
Top NEET SS Surgical Questions
- A post-mastectomy patient (for malignant breast lump) who also had axillary lymph node dissection now presents in the postoperative period (after drain removal) with a soft, fluctuant swelling in the axilla extending into the mastectomy site.
- A patient presents with a large, multilobulated breast tumour clinically suggestive of phyllodes tumour, and there is a significant family history of breast cancer (grandmother) and prostate cancer (father). What is the next step in management?
- In a young woman with a breast lump confirmed on ultrasound to be a simple cyst, what is the next step in management?
- A 45-year-old woman underwent investigations for a breast lump. Her biopsy report confirms invasive ductal carcinoma of the breast. You are the surgical resident in charge and need to communicate the diagnosis to her. What is the most appropriate approach?
- A 35-year-old woman, a chronic smoker, presents with recurrent painful periareolar swelling and purulent nipple discharge for the past 6 months. She has undergone incision and drainage twice, but the symptoms recur after a short period. Which of the following statements about the most likely diagnosis is true?
View More Questions
Top NEET SS Thoracic Surgery Questions
- A young man presents with a history of left-sided chest trauma and difficulty in breathing. On examination, trachea is deviated to the right and percussion note is tympanic. What is the most likely diagnosis?
- In a patient with blunt chest injury, which of the following findings is an indication for emergency thoracotomy?
- A 60-year-old male smoker undergoes bronchoscopy. The image shows an abnormal endobronchial lesion. Which of the following is the most likely diagnosis?
- A patient has undergone pneumonectomy. A postoperative chest X-ray shows an air-fluid level in the pneumonectomy space. Which of the following is the most likely interpretation?
- A patient presents with hyponatremia (128 mEq/L). In which of the following types of lung cancer is this most commonly seen?
View More Questions
Top NEET SS Questions
- A liver transplant patient presents with diarrhoea, colitis, a total leukocyte count of 1800, and a positive blood CMV PCR. What is the next step in management?
- A 32-year-old male recovering from dengue fever initially showed clinical improvement but now presents with recurrence of high-grade fever, fatigue, and pancytopenia on day 10 of illness. He is hemodynamically stable with no bleeding manifestations. Which of the following investigations should be performed first to evaluate the cause of relapse and cytopenia?
- A 48-year-old man with chronic hepatitis C infection is being evaluated for risk factors associated with progression of liver disease. He has a 20-year history of infection, drinks alcohol occasionally, and has a high serum HCV RNA viral load. Which of the following factors is not associated with an increased risk of progression of liver disease in chronic HCV infection?
- A 28-year-old veterinary worker who previously received a full 3-dose pre-exposure rabies vaccination series is bitten by a stray dog while handling an animal in the clinic. The wound is cleaned immediately. What is the most appropriate post-exposure management?
- A 42-year-old patient undergoing chemotherapy for acute myeloid leukemia develops neutropenia (ANC $<$ 500) and is treated with broad-spectrum antibiotics. After initial recovery of neutrophil counts (ANC = 1500), he again develops high-grade fever and right upper quadrant abdominal pain. Imaging shows multiple small hypodense lesions in the liver and spleen. What is the most likely diagnosis?
View More Questions