Surgery MCQs Q18

A 59-year-old male smoker has a chest radiograph showing a cavity with an air-fluid level. Bronchoscopy excludes malignancy.

👉 Question:
What is the most likely diagnosis?

Options:
A. Lung abscess
B. Bronchiectasis
C. Carcinoma of lung
D. Hematoma
E. Pulmonary embolism

✅ Correct Answer:
A. Lung abscess

A. ✅ Lung abscess presents as a cavitary lesion with an air-fluid level on chest X-ray, commonly caused by bacterial infection. Negative bronchoscopy rules out malignancy.
B. Bronchiectasis ❌ – Typically shows tram-track or ring shadows, not a single cavitary lesion with air-fluid level.
C. Carcinoma of lung ❌ – May cavitate but bronchoscopy excluded malignancy in this case.
D. Hematoma ❌ – Usually history of trauma; less likely in this context.
E. Pulmonary embolism ❌ – May cause infarcts but rarely cavitates with air-fluid level.

💡 Lung abscess: necrotizing infection leading to cavity formation with air-fluid level.
💡 Commonly due to aspiration of oral flora, especially in smokers, alcoholics, or debilitated patients.
💡 Clinical features: fever, productive foul-smelling sputum, weight loss, malaise.
💡 Diagnosis: chest X-ray or CT scan.
💡 Treatment: IV antibiotics targeting anaerobes (e.g., clindamycin, beta-lactam/beta-lactamase inhibitor).

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