Consolidation, collapse and cavitation
Paul F. Jenkins in Making Sense of the Chest X-ray, 2013
This chapter discusses the radiographic patterns of pulmonary consolidation and illustrates the various pathological processes that can cause it. It describes the features of partial and complete collapse of the major lobes of the lungs. Whatever the terminology, the radiographic appearances of consolidation are those of homogeneous shadowing in part of the lung field with little or no lobar shrinkage. Consolidated lung may lose volume at any stage in disease progression but the crucial question is whether consolidation is secondary to collapse. Cavitation within an area of consolidation indicates a particular infecting organism or a completely different pathologic process, for example primary lung abscess or a cavitating pulmonary infarct. A unilateral pleural effusion in the presence of consolidation may suggest underlying malignancy or, alternatively, indicate empyema formation. Marked loss of volume of consolidated lung is highly suggestive of underlying, often malignant, disease and also rings alarm bells for further investigation.
Pleuritic chest pain
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
This chapter discusses 'pleuritic chest pain' that will be used to refer to any chest pain that is sharp, well localised and exacerbated by inspiration, regardless of its origin. Pain in general may be divided into three categories, namely somatic, visceral and neuropathic. Somatic pain arises from superficial structures such as the skin, ribs and intercostal muscles, as well as the parietal pleura and pericardium. Pleuritic chest pain refers to pain arising from pleural irritation. It is characterically sharp in nature, well localised and exacerbated by inspiration, and is thus a form of somatic pain, mediated by fast-conducting A-delta fibres. Since pain with very similar characteristics may result from pathology affecting the chest wall or pericardium, these conditions are best discussed together. Potentially life-threatening causes of pleuritic chest pain include pulmonary embolism, tension pneumothorax, pneumonia and empyema. Tension pneumothorax is an immediately life-threatening cause of pleuritic chest pain.
Thoracic trauma
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Atelectasis often develops as a consequence of thoracic trauma or any significant trauma, often due to pain and splinting. Similarly, acute respiratory distress syndrome (ARDS) can be seen as a complication of thoracic trauma but also with severe multisystem injuries. The investigation of paediatric thoracic trauma starts with a chest X-ray in the trauma bay to exclude any injury that needs to be addressed emergently such as pneumothorax. A focused assessment sonography in trauma exam can also be performed in the trauma bay to identify a haemopericardium. The most frequent complications of paediatric chest trauma are atelectasis and pneumonia. Empyema is another complication that may occur with an undrained or inadequately drained haemothorax. Patients present with decreased oxygenation, increased respiratory rate, chest pain and fever. Most often, there will be complete opacification of the affected lung on chest X-ray. The treatment of ARDS relies on supportive measures such as high-frequency oscillatory ventilation.
Chronic tuberculous empyema in an 8-year-old boy
Published in Paediatrics and International Child Health, 2020
Yang Wen, Yu Zhu, Zongrong Gong, Min Shu, Chaomin Wan
Mycobacterium tuberculosis (MTB) as a causative organism of empyema thoracis is rare, especially in children. An 8-year-old boy with tuberculous empyema and no history of contact with tuberculosis presented with minimal symptoms other than mild deformity of the chest wall. He had been vaccinated with bacillus Calmette–Guérin. A chest CT scan demonstrated intrathoracic lymphadenopathy, thickened and calcified pleural rind and rib thickening adjacent to the empyema. The diagnosis was confirmed by post-operative histopathological examination, positive acid-fast stains and DNA PCR. In countries with a high burden of tuberculosis, MTB should be considered in the differential diagnosis of empyema despite minimal symptoms.
Cranial and spinal subdural empyema
Published in British Journal of Neurosurgery, 2009
Pasquale De Bonis, Carmelo Anile, Angelo Pompucci, Maria Labonia, Corrado Lucantoni, Annunziato Mangiola
Subdural empyema represents a loculated suppuration between the dura and the arachnoid. It has been described either intracranially or in the spinal canal, the latter localization being quite rare. It is a rare but serious illness with a declining mortality rate but rather frequent neurological sequelae. Morbidity and mortality in intracranial and spinal subdural empyema directly relate to the delay in diagnosis and therapy. The epidemiology, etiology, pathophysiology and symptoms of spinal subdural empyema and cranial subdural empyema are somewhat different, but brain and spinal subdural empyema are not always two different entities. An adequate treatment strategy should be selected on a case-by-case basis, expecially for patients with a massive CNS involvement, where management represents a challenge.
Empyema necessitans in a six-month-old girl
Published in Paediatrics and International Child Health, 2019
P. Goussard, Robert Gie, Jacques Janson, Savvas Andronikou
Empyema necessitans is a rare complication of acute bacterial pneumonia, especially in children. It is a complication of empyema characterised by the extension of pus from the pleural cavity into the thoracic wall to form a mass of purulent fluid in the adjacent soft tissue. An inflammatory chest wall mass following pneumonia caused by Streptococcus pneumonia in a six-month-old infant is reported. The case emphasises that children presenting with persistent fever and a painful chest wall mass following pneumonia should be investigated immediately as there might be an urgent need for surgery.