Presentation
Kown left lower lobe pneumonia with parapneumonic effusion treated with a chest drain. The patient became increasingly tachypneic three days post drain removal.
Patient Data
Large area of whiteout of left lung with minimal aerated lung at the apex. Large sized pleural effusion with midline shift. Round lucencies at the left lung apex with an air fluid level.
Rounded lucencies at the left lung apex with air/fluid level. Some of which have the appearance of a pneumothorax and some of which look like areas of cavitation.
Near complete consolidation of the left lung with areas of patchy necrosis and cavitation.
Large left sided hydropneumothorax with large volume of gas, enhancing mildly thickened parietal pleura is in keeping with a empyema.
Case Discussion
Given the history of a chest drain and features of a large volume of gas within the left hydropneumothorax, it was favored this patient had developed a bronchopleural fistula and empyema secondary to necrotizing pneumonia.
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