Empyema as a complication of percutaneous lung abscess drainage

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Head and neck cancer, tracheotomy. Fever and evaluate left lower lobe.

Patient Data

Age: 65 years old
Gender: Male

Day 1 at presentation

Modality: X-ray

Left lower lobe thick walled cavitary lesion, CT recommended.

Day 1 at presentation

Modality: CT

Left lower lobe lung thick walled cavitary lesion likely abscess given fever history.

Day 2 of presentation

Modality: CT

Percutaneous lung abscess drainage under CT guidance by Interventional radiology. 15 cc pus drained.

Day 9 of presentation

Modality: X-ray

Pig tail catheter in position. This chest radiograph is done 7 days after chest tube was placed.

IMPRESSION:

Significant interval worsening with a large extrapleural collection, likely an empyema. Significant interval worsening of left lung abscess and pneumonia. There is mediastinal shift to the left. No pneumothorax. Recommend thoracic surgery consultation for VATS drainage.

Day 9 of presentation

Modality: CT

 

Loculated left pleural fluid with thickened, enhancing pleura. 

Day 10 at presentation

Modality: X-ray

Post VATS changes.

Case Discussion

Caution when doing percutaneous lung drainage for lung abscesses. The culture grew Pseudomonas aeroginosa.

Chest radiographs were not performed for 7 days after chest tube placement.

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Case Information

rID: 50944
Case created: 29th Jan 2017
Last edited: 13th Feb 2017
Inclusion in quiz mode: Included

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