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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was a 7 year old male with a 6 day history of high fever and a nonproductive cough.
Clinical Physical Exam:
Clinical Differential Diagnosis:
A PA chest film from the 6th hospital day showed right upper lobe consolidation and a right pleural effusion. An ultrasound guided paracentesis on the 6th hospital day (not provided) returned an exudate consistent with a parapneumonic effusion. The patient did not respond to antibiotics appropriate to Step pneumoniae. A chest ultrasound from the 13th hospital day (not provided) showed multiple septations in the pleural effusion. A chest tube was placed surgically on the 13th hospital day. An enhanced chest CT exam from the 15th hospital day revealed a large right pleural fluid collection that had an enhancing rim with associated consolidation and atelectasis of the lung.
Imaging Differential Diagnosis:
The patient had 3 other chest tubes placed over the next 2 weeks in order to drain the thick pleural fluid.
Follow-up and Prognosis:
The patient eventually resolved the empyema.
Case 5, Case 25
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