Case 14

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

Clinical History:
The patient was a 7 year old male with a 6 day history of high fever and a nonproductive cough.

Clinical Physical Exam:
Febrile.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Pneumonia

Imaging Findings:
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.

Image 1

Image 2

Imaging Differential Diagnosis:
Empyema

Operative Findings:
The patient had 3 other chest tubes placed over the next 2 weeks in order to drain the thick pleural fluid.

Pathological Findings:
None

Final Diagnosis:
Empyema

Follow-up and Prognosis:
The patient eventually resolved the empyema.

Similar Cases:
Case 5, Case 25

References:

• Paediapedia
• WebPath

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