Presentation
Fever and cough.
Patient Data
Bibasilar consolidation, bronchiectasis and bronchial impaction, no pleural effusion.
Bibasilar consolidation and large thick-walled air collection right lateral costophrenic angle.
Bilateral consolidation, bronchiectasis and bronchial impaction right worse than left. Right pleural fluid collection with a split pleura sign. The pleural collection contains air because multiple ectatic bronchi communicate with the pleural space.
Case Discussion
Bronchopleural fistula formation may complicate an empyema, but the communication between the bronchial tree and the pleural space is often subtle and may not be visible on CT. In this case, the communication was obvious, at least in part because of the extensive bronchiectasis. A right pleural drain was placed (not shown), and 400 cc of pus was drained from the right pleural space.
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