They mentioned costophrenic angle to tip you over to empyema rather than abscess. Also abscess would cause productive cough. this kid has nonproductive one
jmorga75As a general (not hard fast rule) Abscesses are more common with cormorbidities and increasing age. Empyemas are more common in kids.
I don't think they can be differentiated without imaging....... +1
jlbaeI was between empyema and abscess too, and I think this is one of those evil NBME questions where there are two answers that could be correct but one is "more correct" than the other. The reason why I think this kid's decreased breath sounds is an important piece of info is that most lung abscesses will be intraparanchymal rather than intrapleural. I also agree with what jmorga75 said - abscesses would be more likely in older patients, chronic alcoholism and/or GERD, poor dentition, etc. +4
Child who has been incompletely treated for pneumococcal pneumonia who presents with high fever, nonproductive cough and diminished breath sounds over lower lung fields with dullness to percussion (suggestive of some form of pleural effusion), most consistent with an empyema
Bronchopleural fistula often seen after trauma, lung abscess often seen secondary to aspiration, pleurodynia leads to sudden sharp chest pain and pneumothorax would lead to diminished breath sounds with hyperresonance to percussion
submitted by โcharcot_bouchard(574)
They mentioned costophrenic angle to tip you over to empyema rather than abscess. Also abscess would cause productive cough. this kid has nonproductive one