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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 25 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 25

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

Chief Complaint:
Two year old female with a complicated pneumonia.

Clinical History:
The patient was a 2 year old female with a necrotizing pneumonia. Blood cultures grew out streptococcus. The patient subsequently developed a right pneumothorax, felt to be caused by the necrotizing pneumonia.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:
Blood cultures positive for streptococcus.

Clinical Differential Diagnosis:

Imaging Findings:
PA chest film demonstrated bilateral airspace disease and a right sided pneumothorax. A chest CT exam from the same day showed an infected right pleural fluid collection, containing air, and a fistula communicating between the lung and the pleural space.

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Imaging Differential Diagnosis:
Empyema / Bronchopleural Fistula

Operative Findings:

Pathological Findings:

Final Diagnosis:
Empyema / Bronchopleural Fistula

Follow-up and Prognosis:
The empyema and bronchopleural fistula resolved.

Similar Cases:
Case 5, Case 14


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