CLINICAL IMAGE
Round pneumonia in an elderly woman Tashfeen Mahmood1, Adeline J. Jou-Tindou2 & Faisal A. Khasawneh3 1
Department of Internal Medicine, Deaconess Hospital, Evansville, Indiana Northwest Texas Hospital, Amarillo Hospitalist group, Amarillo, Texas 3 Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas 2
Correspondence Faisal A. Khasawneh, Section of Pulmonary and Critical Care Medicine, Department of Internal of Medicine, Texas Tech University Health Sciences Center, 1400 S. Coulter Street, Amarillo, TX 79106. Tel: 806-354-5480; Fax: 806-354-5765; E-mail:
[email protected]
Key Clinical Message We describe a case of pneumococcal round pneumonia in an elderly smoker and it demonstrates the role of inflammatory biomarkers and follow-up imaging in ruling out more ominous diagnoses. Keywords Lung infections, round pneumonia.
Funding Information No funding information provided. Received: 6 September 2013; Accepted: 27 November 2013 Clinical Case Reports 2014; 2(1): 15–16 doi: 10.1002/ccr3.42 The authors of this manuscript attest that the content here within represents the views of the authors, and that neither the corresponding author nor the coauthors have submitted duplicate or overlapping manuscripts elsewhere. A written informed consent has been obtained from the patients presented in this case.
Case A 74-year-old smoker female presented with dry cough and shortness of breath. Physical examination identified right lung base crackles. The patient’s white blood cell counts were 11,700/lL. Plain chest radiograph revealed right base infiltrate. A computed tomography (CT) scan of the chest is shown (Fig. 1A and B). What is the diagnosis? Answer: Round pneumonia. Explanation: The patient’s blood cultures were negative, but serum procalcitonin level was elevated and urine pneumococcal
antigen was positive. The patient’s infection resolved with antibiotic therapy (Fig. 2). Round pneumonia is rarely seen in adults because of the development of collateral airways (pores of Kohn and canals of Lambert) by the age of eight [1]. It is a welldefined round consolidation that tends to occur in the upper segments of the lower lobes. Round pneumonia is mostly solitary (98%) and cavitation is not a common feature [2]. Streptococcus pneumoniae is the most common culprit in children and Coxiella burnetii and Legionella micdadei are commonly seen in adults [1]. Differential diagnoses include fungal and mycobacterial infections,
ª 2013 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Round pneumonia in elderly woman
(A)
(B)
Figure 2. Follow-up CT scan cross section showing near-complete resolution of the consolidation. The test was carried out 8 weeks later.
References 1. Cunha, B. A., A. Gran, and J. Simon. 2013. Round pneumonia in a 50-year-old man. Respir. Care 58:e80–e82. 2. Wagner, A. L., M. Szabunio, K. S. Hazlett, and S. G. Wagner. 1998. Radiologic manifestations of round pneumonia in adults. AJR Am. J. Roentgenol. 170:723–726.
Figure 1. (A and B) Computed tomography (CT) scan cross sections showing round consolidation with air bronchogram.
round atelectasis, plural fibroma, bronchogenic cyst, pulmonary pseudotumor, and malignancy [1].
Conflict of Interest None declared.
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ª 2013 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
