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
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Left lower lobe thick walled cavitary lesion, CT recommended.

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

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

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.

Loculated left pleural fluid with thickened, enhancing pleura. 

Post VATS changes.

Case Discussion

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

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

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