Presentation
Fever and chest pain.
Patient Data
Mass-like opacity inferior and posterior right hemithorax with small right pleural effusion.
Large right-sided fluid collection with split pleura sign. The collection forms right angles where it contacts the chest wall and displaces the adjacent lung. Irregular just over 3 cm mass left lung apex, suspicious for lung cancer.
Case Discussion
This case illustrates 2 important points.
1) Although most empyemas form obtuse angles where they contact the chest wall, not all do. In this case, the empyema formed acute angles with the chest wall, but the split pleura sign and the displacement of the lung away from the collection allowed for correct localization.
2) As described above, the empyema is large and a bit atypical in appearance. Remember not to get distracted by the dominant finding and miss other important findings. In this case, in addition to the empyema, there was a left apical mass suspicious for primary lung cancer.
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