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Round pneumonia in an elderly woman
Article first published online: 26 DEC 2013
© 2013 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
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Clinical Case Reports
Volume 2, Issue 1, pages 15–16, February 2014
How to Cite
Clinical Case Reports 2014; 2(1): 15–16
- Issue published online: 6 FEB 2014
- Article first published online: 26 DEC 2013
- Manuscript Accepted: 27 NOV 2013
- Manuscript Received: 6 SEP 2013
- Lung infections;
- round pneumonia.
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.
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/μL. 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.
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 . It is a well-defined 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 . Streptococcus pneumoniae is the most common culprit in children and Coxiella burnetii and Legionella micdadei are commonly seen in adults . Differential diagnoses include fungal and mycobacterial infections, round atelectasis, plural fibroma, bronchogenic cyst, pulmonary pseudotumor, and malignancy .