Presentation
Admitted with right lower lobe pneumonia.
Patient Data
Chest x-ray on admission demonstrates right basal consolidation associated with small right pleural effusion and minor opacity at the left lung base.
X-ray was repeated 5 days later due to an episode of severe respiratory distress. This time demonstrated disease progression with increasing lung opacity and larger right and moderate left pleural effusions.
Case Discussion
Bilateral parapneumonic effusions are a marker of severe pneumonia.
The patient was managed conservatively with IV benzylpenicillin and oral doxycycline as per local guidelines for moderate community acquired pneumonia. Following clinical deterioration, ultrasound guided thoracocentesis of right pleural cavity was performed with marked improvement in symptoms.
Cytology was not performed on pleural fluid due to inadequate specimen volume. The pleural fluid was grossly clear yellow and microscopically showed macrophages and neutrophils with no malignant cells. The leukocyte count was 680 x 106/L.
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