A 69-year-old man with a history of chronic obstructive pulmonary disease/chronic bronchitis is admitted with increasing sputum production, fever, chills, and decreased O2 saturation. His chest x-ray shows a left lower lobe nonhomogeneous opacity. He is treated with IV antibiotics and improves. On the fouh hospital day, prior to discharge, CXR is repeated and the radiologist repos that there is no change as compared to the admission x-ray. Chest x-rays are shown.What will you do next?
This chest x-ray shows an ill-defined, patchy opacity in the left middle and left lower zones. Incomplete consolidation with air bronchogram is seen. The left hea border is clear, but the silhouette of the left diaphragm is lost. This is consistent with the left lower pneumonia. This patient with chronic obstructive pulmonary disease has left lower lobe pneumonia. The clinical history suggests that the patient improved on the fouh hospital day of treatment. Chest x-ray improvement usually lags behind and does not temporally correspond with clinical change. In this case the patient is improving and therefore the best option is to discharge the patient on continued antibiotics. There is no indication for either deferring the discharge or resuming IV antibiotics on the basis of a nonresolving x-ray at this stage. Bronchoscopy for drainage would not be indicated, and obtaining a CT scan would not alter the treatment or management plan at this stage.
Obtain a CT scan to rule out abscess
Defer discharge and resume IV antibiotics
Schedule a pulmonary consult for bronchoscopy to improve bronchial drainage
Discharge the patient on oral antibiotics
Respiratory system