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Thoracic empyema

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

One week history of fevers, runny nose, non-productive cough, and myalgias.

Patient Data

Age: 55 years
Gender: Male

Chest

x-ray

There is a right posterior and paramediastinal mass-like lesion that has relatively well-defined margins on its right aspect. There is no volume loss in the right hemithorax or mediastinal shift. The cardiomediastinal contours are otherwise normal. Costophrenic recesses are normal. 

Chest

ct

CT confirms a large loculated pleural based collection that is associated with pleural thickening/enhancement and that compresses and causes the partial collapse of the right lower lobe. 

Chest (1 day later)

x-ray

A right-sided intercostal catheter with a marked volume reduction of the right-sided empyema. Lungs and pleural spaces are otherwise clear, no pneumothorax.  

Right pleural fluid - Report
3+ Streptococcus anginosus group
Gram Stain Report
Polymorphs...................... 2+ 
Gram positive cocci............. 2+

Macroscopic Exam Report
Cloudy
Viscous fluid with particulate matter
Cell count not performed

Chest (5 days later)

x-ray

The right-sided catheter has been removed. Further improvement of the right paramediastinal changes, most likely a component of residual loculated fluid and atelectasis. 

Case Discussion

Typical imaging features of thoracic empyema

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