PMC5287989_01
PMC5287989_02
Chest radiograph with a collection of fluid in the left pleural cavity (9 April 2015). A marked infiltration of the basal segments of the left lower lobe is presented
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fig1
On admission, her chest radiograph revealed subtle patchy consolidation in the left lower lobe and collection of fluid in the left pleural cavity (Fig. 1).
Chest radiograph following one month after the initial investigation. Two air-fluid levels are clearly visible in the left side
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fig2
However, her general condition deteriorated and localized left pyopneumothorax was diagnosed (Figs. 2, 3).
A lateral view
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fig3
However, her general condition deteriorated and localized left pyopneumothorax was diagnosed (Figs. 2, 3).
Same-day CT scan of the chest. The contrast medium is clearly visible in the stomach. A short communication of the stomach lumen with the left pleural cavity through the diaphragmic defect was evaluated
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fig4
Further work-up included fiberoptic gastroscopy and a computed tomography scan of the chest (Fig. 4).
An intraoperative view. A large defect of the stomach fundus is clearly visible in the centre of the operative field
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fig5
A huge ventriculopleural communication (about 5 cm in diameter) and a defect in the diaphragm were evaluated (Fig. 5).
A postoperative view after Eloesser open-flap formation. Left, a defect of the fundus is visible in the centre of eroded left diapfragm; right, the lower lobe of the left lung
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An open-window thoracostomy was created in order to facilitate treatment by daily packing of the cavity (Fig. 6).
Chest radiograph taken seven months after the first operation (15 December 2015). Just a small area of parenchymal consolidation can be seen in the left lung
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fig7
The thoracostomy opening healed spontaneously during the following six months (Fig. 7, 8).
A postoperative view of the chest wall seven months after the first surgical procedure
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fig8
The thoracostomy opening healed spontaneously during the following six months (Fig. 7, 8).