PMC9428849_01
Day 1 chest x-ray on admission.. Impression: No consolidation, no pneumothorax. Prominent perihilar lung markings bilaterally.
gr1.jpg
PMC9428849_01_gr1.jpg
fig1
Initial chest x-ray (Fig. 1) showed no signs of consolidation.
Day 3 chest x-ray.. Impression: Interval development of large left tension pneumothorax post attempted left sided central venous line placement. Interval development of right lower lobe consolidation.
gr2.jpg
PMC9428849_01_gr2.jpg
fig2
Left subclavian central venous line was attempted and was complicated by left sided pneumothorax (Fig. 2).
Day 8 chest x-ray.. Impression: Worsening right lower lobe consolidation and development of right pleural effusion. Resolution of left sided pneumothorax.
gr3.jpg
PMC9428849_01_gr3.jpg
fig3
Her interval chest x-ray later showed a worsening right middle and lower lobe consolidation (Fig. 3), concerning for pneumonia.
Day 8 CT Chest with IV contrast.. Impression: Large loculated right pleural effusion primarily collecting at the right lung base and along the right lateral periphery.
gr4.jpg
PMC9428849_01_gr4.jpg
fig4
Over the next 5 days, she developed a large loculated right sided pleural effusion demonstrated on chest CT and x-ray (Fig. 4).
Day 12 CT Chest with IV Contrast.. Impression: Interval placement of right sided chest tube with significant decrease in loculated right pleural effusion with small residual effusion in the right lung base.
gr5.jpg
PMC9428849_01_gr5.jpg
fig5
Her hospitalization course improved with a 10-day course of piperacillin-tazobactam, thoracostomy tube drainage, and alteplase/dornase alfa infusions for fibrinolysis of the loculations (Fig. 5, Fig. 6).
Day 78 Ambulatory post-antibiotic chest x-ray.. Impression: No focal consolidation or pneumothorax. Resolution of previous right empyema.
gr7.jpg
PMC9428849_01_gr7.jpg
fig7
Augmentin with follow up with the Infectious Disease clinic. At the follow up visit, the patient's respiratory symptoms were completely resolved, and her repeat chest x-ray (Fig. 7) showed complete resolution of pulmonary consolidations and empyema.