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