Cavitating pneumonia with empyema

Case contributed by Henry Knipe


One week of cough, dyspnea and one day of right-sided chest pain.

Patient Data

Age: 20-25 years
Gender: Male

Right upper lobe consolidation with air bronchograms and a small lucency laterally. No pleural effusion. 

The patient was admitted and treated for pneumonia. A follow-up chest x-ray was performed one day later for increased shortness of breath. 

One day later


New right parapneumonic pleural effusion forming an obtuse angle with the chest wall, possibly indicating loculation. Right upper lobe consolidation with increased internal lucency.

Right upper lobe consolidation with cavitation. Right pleural effusion appears loculated forming obtuse angles with the chest wall. No pleural enhancement or intrapleural gas. 

Case Discussion

The loculated pleural effusion is concerning for empyema in the setting of cavitating pneumonia even without other CT findings of pleural enhancement or intrapleural gas. The patient subsequently had video-assisted thoracoscopic surgery (VATS), which confirmed pleural empyema. 

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