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Introduction Chest pain is a common diagnosis in children in puberty and adolescents. Lung abscess is a rare cause of chest pain. It occurs as a result of a lung infection that has led to suppurative necrosis and destruction of the affected lung parenchyma. We classify them as primary or secondary, depending on whether there is a pulmonary or systemic disorder. The most common causes of primary abscess are Streptococcus pneumoniae, Staphylococcus aureus and oral bacteria, while the cause of secondary abscess is Pseudomonas aeruginosa, but fungal infections can also be found. Symptoms appear gradually, over several weeks, such as chest pain, cough, fatigue, chills, decreased appetite with weight loss, night sweats, purulent sputum with a sour taste and an unpleasant odor often mixed with blood. After the diagnosis (radiological), taking microbiological materials, empirical broad-spectrum antibiotic therapy is started. Invasive procedures such as surgical open drainage, lobectomy and/or percutaneous drainage are reserved for cases refractory to conservative treatment. Case Report This is a 14-year-old boy with symptoms of chest pain who appeared the night before the examination in the emergency pediatric clinic. The pain was severe, located in the left side of the chest, exacerbated by inhalation and changes in body position with dyspnea. The analgesic is of lesser intensity. The auscultatory left basal quieter breathing noise is in status. A slight increase in surrogate markers of inflammation was present in the laboratory findings, while radiological processing (X-ray of thoracic organs, ultrasound of the lungs and MSCT of the thorax) verified a vaguely limited nodular shadow about 4 cm in size at the height of the left hilus. A biopsy of the formation was performed. Cytological analysis of the contents revealed the diagnosis of abscess. He was treated with parenteral antibiotics ceftriaxone and clindamycin for 16 days. Conclusion Chest pain is one of the common symptoms in an emergency pediatric clinic. The most common pain is benign, musculoskeletal, emotional or idiopathic. Cardiac and pulmonary etiology (ECG, thoracic X-ray, troponin, D-dimers, LDH) should always be ruled out. In this case, we wanted to present a lung abscess as one rare diagnosis that can only be presented by chest pain. It was difficult for the patient to distinguish whether it might be a malignant disease, which we should also consider when treating a patient whose verification of the formation of unclear etiology is verified. |
