Pyopneumothorax
Updates to Article Attributes
Pyopneumothorax (also known as infected hydropneumothorax hydropneumothorax or empyemic hydropneumothorax) is a pleural collection of pus and air. It may be thought of a variant of a thoracic empyema with air containing components although the aetiology may be different.
Clinical presentation
The patient usually presents with chest pain and fever. Cough and breathing difficulty may be present.
Pathology
As with a hydropneumothorax, it has a range of causes:
- thoracentesis
- thoracic trauma
- bronchopleural fistula
- oesophagopleural fistula
Many causative organisms have been implicated including Mycobacterium tuberculosis, anaerobes, pyogenic and fungal.
Radiographic features
Plain film
An air-fluid level is noted. It may be loculated. Loss of silhouette with the dome of diaphragm may be seen. It may be difficult to differentiate a pyopneumothorax from non-infected hydropneumothorax. Presence of thick pleural lining strongly favours the former.
Ultrasound
Fine internal echoes in the pleural collection strongly suggests infected fluid in appropriate clinical settings.
CT
CT will clearly depict the location of the collection as well as thickening of pleura and underlying disease process (if any).
Treatment and prognosis
Large collections require intercostal drainage with antibiotics.
Differential diagnosis
On imaging consider
- non-infected hydropneumothorax (no pleural thickening)
- peripheral lung abscess
- previous empyema with iatrogenic introduction of air (e.g. drain insertion or diagnostic aspiration etc.)
-<p><strong>Pyopneumothorax </strong>(also known as <strong>infected hydropneumothorax</strong> or <strong>empyemic hydropneumothorax</strong>) is a pleural collection of pus and air. It may be thought of a variant of a <a href="/articles/thoracic-empyema-1">thoracic empyema</a> with air containing components although the aetiology may be different.</p><h4>Clinical presentation</h4><p>The patient usually presents with chest pain and fever. Cough and breathing difficulty may be present.</p><h4>Pathology</h4><p>As with a <a href="/articles/hydropneumothorax">hydropneumothorax</a>, it has a range of causes:</p><ul>- +<p><strong>Pyopneumothorax </strong>(also known as <strong>infected hydropneumothorax</strong> or <strong>empyemic hydropneumothorax</strong>) is a pleural collection of pus and air. It may be thought of a variant of a <a href="/articles/thoracic-empyema-1">thoracic empyema</a> with air containing components although the aetiology may be different.</p><h4>Clinical presentation</h4><p>The patient usually presents with chest pain and fever. Cough and breathing difficulty may be present.</p><h4>Pathology</h4><p>As with a <a href="/articles/hydropneumothorax">hydropneumothorax</a>, it has a range of causes:</p><ul>
-<li>peripheral <a href="/articles/lung-abscess">lung abscess</a> </li>- +<li>peripheral <a href="/articles/lung-abscess">lung abscess</a>
- +</li>
Image 5 X-ray (Frontal) ( create )
Unable to process the form. Check for errors and try again.