Presentation
Shortness of breath and weight loss.
Patient Data
Right sided mid to lower zone consolidation. Bilateral pleural effusions, right more than left. Right sided shoulder dislocation (chronic).
Near complete consolidation of the right lower lobe with internal liquification in keeping with a multilocular abscess formation associated with a small to moderate pleural effusion with internal septa and pleural enhancement in keeping with a multilocular empyema.
Occlusion of the right lower lobe bronchus with mucus present within bronchus intermedius, right main bronchus and trachea.
Left sided pleural effusion with associated compressive atelectasis.
Large hiatus hernia.
Thick-walled bronchi in the left lower lobe may indicate chronic aspiration.
Right shoulder dislocation (chronic).
Case Discussion
This case shows co-existing lung abscess with pleural empyema.
CT is reliable in the differentiation of these two entities. Note the enhancing pleural separation between visceral and parietal pleural (split pleura sign) as well as the lenticular shape of the pleural empyema while the abscess has more of a round shape and contained within the lung parenchyma. Moreover, a lung abscess tends to have varying wall thickness in comparison to the thin smooth wall of an empyema1,2.