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Empyema

Berry JNB - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Wilford Hall USAF Medical Center

ABSTRACT

Diagnosis: Empyema

History: 19 y/o male s/p facial and upper body burns without inhalation injury, history of intubation, mechanical ventilation, and multi-organism pneumonia with recurrent left-sided effusions requiring drainage with chest tubes. Extubated, chest tubes removed, and transferred to Ward after initial clinical improvement. Patient complained of being short of breath with exertion after a few days on the Ward. PA and lateral chest radiographs were obtained.

Findings: PA and lateral chest radiographs significant for an air-fluid level in the left mid-posterior chest (heart and mediastinal outlines preserved on PA, clearly posterior on lateral), silhouetting of the left hemidiaphram, and LLL/lingula air space disease. Axial CT of the chest with IV contrast significant for a loculated, rim-enhancing fluid collection with multiple pockets of air, consistent with a bronchopleural fistula vs. infection with a gas-forming organism, in the left posterior-lateral chest. The split-pleura sign is also present. CT findings also significant for air space consolidation with air bronchograms in the LLL and lingula.

Ddx: The air fluid level on the PA and lateral chest radiographs could represent: <li> an empyema with a bronchopleural fistula vs. infection with gas-producing organism <li> an abscess in the lung parenchyma with a bronchopleural fistula vs. infection with gas-producing organism <li> loculated pleural effusion and pneumothorax <li> a pneumatocele with bronchopleural fistula <li> post-traumatic hemothorax with bronchopleural fistula The axial CT of the chest findings are classic and pathognomonic for a thoracic empyema.

Dxhow: Gram stain and culture of the pleural fluid, surgical exploration.

Exam: Vitals: T 98.9 F, P 112, BP 112/68, RR 20, POx >95% on room air. Physical exam significant for decreased breath sounds on left side. Labs significant for WBC 19.3 with 78% segs. Chem 7, total protein, and albumin all WNL.

No MeSH data available.


Rim enhancement is seen and the split-pleura sign is demonstrated in the anterior-lateral and posterior-medial portions of the left hemi-thorax, indicating that the lesion is indeed an empyema. The empyema contains multiple areas of gas, indicating loculations within the pleural space. Also seen are likely areas of necrosis in the area between the consolidated lung and the pleura, suggestive of multiple small bronchopleural fistulas. There is air space consolidation with multiple air bronchograms.
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MPX2263_synpic20905: Rim enhancement is seen and the split-pleura sign is demonstrated in the anterior-lateral and posterior-medial portions of the left hemi-thorax, indicating that the lesion is indeed an empyema. The empyema contains multiple areas of gas, indicating loculations within the pleural space. Also seen are likely areas of necrosis in the area between the consolidated lung and the pleura, suggestive of multiple small bronchopleural fistulas. There is air space consolidation with multiple air bronchograms.


Empyema

Berry JNB - MedPix

Rim enhancement is seen and the split-pleura sign is demonstrated in the anterior-lateral and posterior-medial portions of the left hemi-thorax, indicating that the lesion is indeed an empyema. The empyema contains multiple areas of gas, indicating loculations within the pleural space. Also seen are likely areas of necrosis in the area between the consolidated lung and the pleura, suggestive of multiple small bronchopleural fistulas. There is air space consolidation with multiple air bronchograms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2263&req=5

MPX2263_synpic20905: Rim enhancement is seen and the split-pleura sign is demonstrated in the anterior-lateral and posterior-medial portions of the left hemi-thorax, indicating that the lesion is indeed an empyema. The empyema contains multiple areas of gas, indicating loculations within the pleural space. Also seen are likely areas of necrosis in the area between the consolidated lung and the pleura, suggestive of multiple small bronchopleural fistulas. There is air space consolidation with multiple air bronchograms.

View Article: MedPix Image - MedPix Case

Affiliation: Wilford Hall USAF Medical Center

ABSTRACT

Diagnosis: Empyema

History: 19 y/o male s/p facial and upper body burns without inhalation injury, history of intubation, mechanical ventilation, and multi-organism pneumonia with recurrent left-sided effusions requiring drainage with chest tubes. Extubated, chest tubes removed, and transferred to Ward after initial clinical improvement. Patient complained of being short of breath with exertion after a few days on the Ward. PA and lateral chest radiographs were obtained.

Findings: PA and lateral chest radiographs significant for an air-fluid level in the left mid-posterior chest (heart and mediastinal outlines preserved on PA, clearly posterior on lateral), silhouetting of the left hemidiaphram, and LLL/lingula air space disease. Axial CT of the chest with IV contrast significant for a loculated, rim-enhancing fluid collection with multiple pockets of air, consistent with a bronchopleural fistula vs. infection with a gas-forming organism, in the left posterior-lateral chest. The split-pleura sign is also present. CT findings also significant for air space consolidation with air bronchograms in the LLL and lingula.

Ddx: The air fluid level on the PA and lateral chest radiographs could represent: <li> an empyema with a bronchopleural fistula vs. infection with gas-producing organism <li> an abscess in the lung parenchyma with a bronchopleural fistula vs. infection with gas-producing organism <li> loculated pleural effusion and pneumothorax <li> a pneumatocele with bronchopleural fistula <li> post-traumatic hemothorax with bronchopleural fistula The axial CT of the chest findings are classic and pathognomonic for a thoracic empyema.

Dxhow: Gram stain and culture of the pleural fluid, surgical exploration.

Exam: Vitals: T 98.9 F, P 112, BP 112/68, RR 20, POx >95% on room air. Physical exam significant for decreased breath sounds on left side. Labs significant for WBC 19.3 with 78% segs. Chem 7, total protein, and albumin all WNL.

No MeSH data available.