Presentation
Shortness of breath, dry cough and pleuritic chest pain in a smoker. Past history of PE, pleural effusion with right middle lobe collapse and negative bronchoscopy.
Patient Data
19.6 x 20.1 cm loculated pleural collection containing with gas-fluid level. Occluded bronchus intermedius and compression atelectasis of the right middle and lower lobes. Contralateral mediastinal shift. Subcarinal lymphadenopathy.
Large loculated gas and fluid collection occupying the lower two thirds of the right hemithorax.
No significant change.
Following thoracentesis
Pigtail catheter with resolution of the large pleural collection, new basal pneumothorax and persistent lower zone atelectasis. Right upper lobe and left lung remain clear. The heart shadow is enlarged.
Following decortication
Partial re-expansion of the right middle and lower lobes. Resolving right pneumothorax.
Case Discussion
It is important to make the distinction between lung abscess and empyema. 2L of pleural fluid was drained and cultures grew gram positive and gram negative bacteria. Extensive pleural peel was seen during the VATs procedure and partial decortication was performed.
Serial CXRs showed progressive re-expansion of the R lung and this was accompanied by complete resolution of dyspnea.
Case authors: Taner B. Celebi D.O. and Aleksandra Polonetskaya M.D.
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