CXR Case 093

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.

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

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.