With the presenting complaints and first chest X-ray, a provisional diagnosis of thoracic empyema was made. 

Subsequently the patient underwent a CT scan which showed the extent and involvement of the disease process. There was also a suspicion of an esophageal-pleural fistula on contrast enhanced images and thus subsequently an oral contrast study was performed. On oral contrast administration, there was no evidence of fistula, but it appeared as if the esophagus was thickened (endoscopy was performed which turned out to be normal).

Finally, in view of imaging findings and patient presentation, a diagnosis of thoracic empyema with mediastinitis was made and intercostal drainage performed which confirmed the presence of an infected purulent effusion.