Demographics:
47 years old, Male
Indication:
Empyema
Findings
Chest radiograph
- Moderate-sized, partially loculated right hydropneumothorax with apically-directed right thoracostomy tube in place
- Marked right visceral pleural thickening
- Right basilar patchy opacities
- Right chest wall subcutaneous emphysema
CT
Chest
- Moderate-sized right hydropneumothorax with multiple locules of gas intermixed with dependent fluid suggesting multiloculation
- Right visceral and parietal pleural thickening
- Area of consolidation with internal cavitation in the anterior aspect of the right upper lobe with direct communication between areas of cavitation and the pleural space
- Right thoracostomy tube with tip directed toward the right lung apex
- Mild dependent atelectasis in the right lower lobe
- Widespread bronchial wall thickening
- Mild left upper lobe scarring
- Thoracic aortic atherosclerosis without aneurysm
- Moderate coronary artery calcification
Upper abdomen
- No acute findings
MSK
- Extensive right chest wall subcutaneous emphysema extending into the neck
- Remote healed bilateral rib fractures
Diagnosis
Bronchopleural fistula
Sample Report
Moderate-sized multiloculated right hydropneumothorax with apically-directed right thoracostomy tube in place, consistent with the clinical suspicion for empyema.
Focal area of consolidation and cavitation in the anterior aspect of the right upper lobe with an associated bronchopleural fistula. This area of consolidation could represent an abscess or cavitary neoplasm.
Extensive right chest wall subcutaneous emphysema.
Discussion