Thoracic empyema

Case contributed by Sachi Hapugoda
Diagnosis probable


Hematemesis. Lethargy and weight loss. Lifelong smoker. From Vietnam. Nil dyspnea, cough or fevers.

Patient Data

Age: 70 years
Gender: Male

Large cavitating lesion of the right lower lobe upto 8.8cm. Right sided pleural effusion. Right apical pleural thickening.


Large loculated pleurally based collection containing a large volume of gas. This is located postero-inferiorly extending into the right oblique fissure producing marked pleural thickening and enhancement. There is suspicion for a pleuroparenchymal fistula.

Right lower lobe subsegmental compressive atelectasis is present.

12 mm focus of consolidation in the posterior segment of the right upper lobe.

4 mm calcified right hilar lymph node. The remaining mediastinal and hilar lymph nodes are unremarkable with no evidence of lymphadenopathy.  

Case Discussion

The patient responded well to tube thoracoscopy with prolonged antibiotic therapy. Cultures were unremarkable. No evidence of tuberculosis with positive adenosine deaminase rendering bacterial empyema less likely. Pleural biopsy revealed nil evidence of malignancy. The cause remains uncertain.

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