Presentation
Shortness of breath, fever and cough for one week.
Patient Data
Ground glass consolidations at the right mid and lower lung zones. Loculated right pleural effusion which is suspicious of pleural empyema. No left pleural effusion.
Endotracheal tube with the distal tip at T3 vertebral level.
Low-attenuating (fluid density) consolidations with minimal internal peripheral enhancement noted at the right middle lobe and right lower lobe. These consolidations bulge the adjacent lower part of right oblique fissure (bulging fissure sign). A few air pockets and air bronchograms seen within the right lower lobe consolidation.
A tiny calcified lung nodule at the posterobasal segment of right lower lobe.
Numerous centri-lobular nodules with tree-in-bud appearance and ground glass opacities at bilateral upper lobe and bilateral lower lobes (predominantly at superior segments).
Enlarged mediastinal lymph nodes at the subcarinal and right paratracheal regions.
Loculated right pleural effusion with abnormal enhancing pleura "split pleural sign". Multiple enhancing strands seen within this pleural collection suggest the complexity of the collection.
Mild degree of left pleural effusion.
Passive compressive lung atelectasis at adjacent bilateral lower lobes.
A few hypodense lesions at bilateral thyroid.
Two foci of calcification (subcentimeter) noted at the liver segment VII. Ascites at the upper abdomen.
Case Discussion
Low attenuating consolidations at the right middle and right lower lobes are imaging features to suggest necrotizing pneumonia. No CT evidence to suggest lung abscess. Right pleural empyema.
Patient's sputum cultured Klebsiella pneumoniae. Bulging fissure sign can be appreciated in CT scan where the expanded consolidation at the right lower lobe displaces the lower half of right oblique fissure anteriorly.
Close monitoring is warranted to watch out complications such as cavitating pneumonia and lung abscess in this patient.
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