CXR Case 093

A 37 year old man is transferred from a peripheral hospital with acute shortness of breath.

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Describe and interpret this CXR

CHEST X-RAY INTERPRETATION

There is diffuse, hazy shadowing in the right lower lung field with an indistinct lateral right hemidiaphragm and fluid in the horizontal fissure.

Thoracic ultrasound demonstrates a multiloculated basal pleural effusion with underlying consolidated lung.


CLINICAL CORRELATION

This is a complex, loculated parapneumonic effusion that later grew Streptococcus milleri.


CLINICAL PEARLS

Sir William Osler proposed that empyema should be considered an abscess needing “2 inches of cold steel, not a damn fool of a physician“.

He later died of empyema after a 9th rib resection in his home in 1919.


TOP 150 CXR SERIES



Prof Fraser Brims Curtin Medical School, acute and respiratory medicine specialist, immediate care in sport doc, ex-Royal Navy, academic| Top 100 CXR | Google Scholar |

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