Correct!
3. The thoracic CT shows a multiloculated right pleural space collection suggesting the diagnosis of empyema
The thoracic CT shows a complex right-sided fluid collection creating obtuse angles with the chest wall, indicating an extraparenchymal origin. The complex fluid is peripherally positioned, which is inconsistent with a primary mediastinal origin. There is no rib destruction or chest wall mass to suggest the process arises from these structures; rather, the appearance is consistent with a pleural space origin. A small focus of gas seen superiorly is consistent with the recent ultrasound-guided thoracentesis. Although the thoracic CT was performed without intravenous contrast, peripheral smooth parietal pleural thickening is evident. Extensive medial right lung consolidation is present. The appearance of a multiloculated pleural space collection with smooth pleural thickening is highly suggestive of empyema.
Streptococcus intermedius was recovered from the right-sided ultrasound-guided thoracentesis. The patient subsequently underwent surgical decortication. One pleural fluid loculation remained along the anteromedial right thorax following the surgical procedure, and was successfully drained percutaneously. The patient subsequently recovered uneventfully.
Diagnosis: Empyema secondary to Streptococcus intermedius
References