What are the causes of a pyopneumothorax?
Causes of pyopneumothorax include thoracentesis, trauma, bronchopleural fistula and oesophageal or gastro-pleural fistula.
What would you do next?
The hiatus hernia and close proximity of the gastric wall to the gas/fluid collections favoured the diagnosis of an oesophageal or gastro-pleural fistula. Therefore, a water soluble contrast swallow was performed.
Large multiloculated left pyopneumothorax with air-fluid level, enhancing walls and split-pleura sign. The largest pleural collection occupies the left mid/lower hemithorax (12 cm x 10 cm x 15 cm) and communicates with the smaller left costophrenic collection. Moderate hiatus hernia whereby the stomach abuts the large collection.
Consolidation and collapse of the adjacent left lung. No mediastinal lymphadenopathy. Fibrocalcific scarring at both lung apices in keeping with previous TB.