Presentation
7-month follow-up of empyema. TB diagnosed 5 years ago.
Patient Data
Non-contrast CT of the chest reveals a thick rind of pleura in the small volume right hemithorax with thick irregular calcification involving both visceral and parietal pleura encasing a hypodense loculated pleural collection with an air-fluid level. There is associated extrapleural fat proliferation and volume loss in the right hemithorax with mild thickening and crowding of the ribs.
A small area of pulmonary consolidation with an air bronchogram inside is seen in the right middle lobe.
Fine reticulonodular densities are seen also affecting the right lung parenchyma, mainly the lower lobe.
A linear atelectatic band is seen at the anterior segment of the left upper lung lobe.
Few enlarged non calcified reactive mediastinal lymph nodes are also noted.
Case Discussion
Thick, calcified visceral and parietal pleural rind with split pleura sign compatible with prior tuberculous empyema. Extrapleural fat proliferation and rib thickening are sequelae of chronic inflammation. The small volume of the right lung suggests trapped lung. In this situation, hydropneumothorax commonly follows pleural aspiration due to the abnormally low pleural pressure. Gas can enter the pleural cavity through an aspiration device or through pleural micro-tears.