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Case 186: Epigastric pain and fever

A 25 year old woman has been celebrating the end of her exams. Over the last few days she has been binge drinking. She now presents with epigastric and right upper quadrant pain associated with fever. The emergency department call you to see her as suspected complicated pancreatitis.

1. What is the diagnosis?

The chest xray shows an air fluid level in the right hemithorax in the region of the middle lobe. This would indicate a lung abscess likely secondary to aspiration during an episode of intoxication.

2. What investigations would you arrange?

A CT chest is useful to confirm the diagnosis and the anatomical location of the abscess. Sputum should be sent for microbiology. A bronchoscopy may be required to obtain adequate material for culture.

Pancreatitis or other complications of alcohol abuse should be excluded with appropriate investigations such as serum amylase or lipase.