Loculations were seen in 40 patients out of which 14 were complicated parapneumonic effusion and 26 were loculated empyema
. Parenchymal lesions suggestive of pulmonary tuberculosis were seen in 13 patients.
A repeat CT chest abdomen pelvis with contrast 5 days later was ordered which showed septic emboli in the lungs bilaterally, splenic emboli, bilateral loculated empyema
, and left adrenal gland hemorrhage (Figure 4).
The criteria for surgical intervention were the presence of loculated empyema
with thickened pleura on computed tomography (CT) scan of the chest, which was noted in 17 out of 18 patients.
Emergent chest tube diagnosed and relieved a large loculated empyema
. It was further treated with fibrinolytics (tissue plasminogen activator) and dornase alpha since surgery was nonoptional due to multiorgan failure and septic shock.
The chest X-ray showed a massive loculated empyema
on the right with an ipsilateral foreign body in the upper chest, which appeared to be in the esophagus (Figure 3).
Today was the day for pleural effusions: a tuberculous a cardiac a renal a septic and a loculated empyema
. Each case was successively presented by a student; the differences among the clinical features of each became self-evident.
In addition to being safer, ultrasound produces better imaging than CT in patients with a pleural-space infection "to sort out who has a loculated empyema
that needs VATS [video-assisted thoracic surgery] and who has a nonloculated effusion that generally doesn't need VATS," said Dr.
Among 17 (14%) patients who required surgical intervention, 15 had suppurated lymph nodes requiring incision and drainage, and two developed a loculated empyema
requiring thoracotomy and decortication.
Only 10 patients with MSSA had pulmonary complications: 2 had a primary diagnosis of pneumonia and also had loculated empyema
, 6 had bone or joint infections, and 2 had endocarditis.
Both of these children also had loculated empyema
. Six had bone or joint infections, and two had endocarditis.
It decreases the morbidity and length of hospitalization in loculated empyema