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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
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 Differential Diagnosis:
Empyema, lung abscess
A chest CT exam was obtained to better evaluate the nature of the patient's complicated pneumonia.
Images 2 and 3
Imaging Differential Diagnosis:
Empyema with lung abscess and bronchopleural fistula
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.
Case 14, Case 25, Case 28, Case 52
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