Bilateral parapneumonic effusions

Case contributed by Ijaza Irzan
Diagnosis almost certain

Presentation

Admitted with right lower lobe pneumonia.

Patient Data

Age: 90 years
Gender: Female

Chest x-ray on admission demonstrates right basal consolidation associated with small right pleural effusion and minor opacity at the left lung base.

5 days later

x-ray

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 negative for malignancy. MC&S was negative for bacterial growth. The pleural fluid was grossly clear yellow and microscopically showed macrophages and neutrophils with a leukocyte count of 680 x 106/L.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.