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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.


Similar findings as in prior images. The air bronchograms are particularly well seen in this image.
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MPX2263_synpic20907: Similar findings as in prior images. The air bronchograms are particularly well seen in this image.


Empyema

Berry JNB - MedPix

Similar findings as in prior images. The air bronchograms are particularly well seen in this image.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

MPX2263_synpic20907: Similar findings as in prior images. The air bronchograms are particularly well seen in this image.

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.