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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 5 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 5

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Fourteen year old male with a complicated pneumonia

Clinical History:
The patient was a 14 year old male who was diagnosed with a right lower lobe pneumonia that initially was non responsive to oral antibiotics. He was subsequently hospitalized at an outside hospital, where he developed an empyema and was non responsive to IV antibiotics and the placement of a pigtail catheter for empyema drainage. He was transferred to our institution where a large bore chest tube was surgically placed for empyema drainage and new IV antibiotics were started.

Clinical Physical Exam:
The patient was febrile.

Clinical Labs:

Clinical Differential Diagnosis:
Empyema, lung abscess

Imaging Findings:
A chest CT exam was obtained to better evaluate the nature of the patient's complicated pneumonia.

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icon gificon gifImages 2 and 3

Imaging Differential Diagnosis:
Empyema with lung abscess and bronchopleural fistula

Operative Findings:

Pathological Findings:

Final Diagnosis:
Lung Abscess, Empyema, Bronchopleural Fistula

Follow-up and Prognosis:
The chest tube was removed so that the bronchopleural fistula would not progress. A repeat spiral chest CT exam obtained 3 weeks later (not provided) showed substantial improvement of the disease in the right hemithorax, with the bronchopleural fistula being no longer demonstrated.

Similar Cases:
Case 14, Case 25, Case 28, Case 52


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