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.
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.