Demographics:
24 years old, Female
Indication:
Evaluate empyema
Findings
Chest radiograph
- Right thoracostomy tube with tip overlying the right lung apex
- Moderate-sized, partially loculated right pleural fluid collection
- Bilateral patchy and nodular airspace opacities
- Bilateral clavicular screws
CT
Chest
- Right thoracostomy tube with tip at the apex
- Moderate-sized, multiloculated right hydropneumothorax with associated visceral and parietal pleural thickening and extension of fluid through the right fourth and fifth intercostal spaces with a thin subpectoral fluid and gas collection in the right chest wall measuring 10 x 1.5 x 7.5 cm
- Multiple peripheral nodules throughout both lungs, many of which are cavitary
- Dependent consolidation in both lower lobes
- Asymmetric interlobular septal thickening in the right lung
- Fat stranding throughout the mediastinum without discrete fluid collection or pneumomediastinum
Upper abdomen
- No acute findings
MSK
- Right chest wall findings as discussed above
- No acute osseous findings
- Paired screws in both clavicles
Diagnosis
Empyema necessitans
Septic embolic disease
Sample Report
Moderate-sized, multiloculated right hydropneumothorax consistent with empyema with extension into the right chest wall, concerning for emphysema necessitans.
Bilateral peripheral nodular opacities, many of which are cavitary, which is primarily concerning for septic embolic disease. Consider transesophageal echocardiography to evaluate for cardiac valvular vegetations.
Many of these nodules border the mediastinal pleura. Fat stranding in the mediastinum may represent mediastinitis, though there is no discrete mediastinal abscess.
Discussion
References