Empyema

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A five-year old male presents to his pediatrician’s office with a fever and cough. A community acquired pneumonia is diagnosed on chest radiograph. He is treated as an outpatient with oral antibiotics but returns three days later with worsening dyspnea and a large left pleural effusion on repeat chest radiograph. They are admitted and started on broad spectrum IV antibiotics with persistent fevers and an increasing oxygen requirement. A CT scan is obtained which shows a loculated pleural effusion. [size=20px]What is the best next step in management of this patient? a Chest tube alone b Continued IV antibiotic therapy c Chest tube/Fibrinolysis d V…

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A previously healthy four-year old girl was admitted to the hospital 3 days ago with a diagnosis of pneumonia. She was started on appropriate broad spectrum antibiotics based on organisms from her sputum culture. She continues to have fevers and a productive cough. Although the initial chest radiograph was consistent with pneumonia, the most recent radiograph revealed an air fluid level. A computerized tomography scan is shown with no evidence of foreign body. The best next step in the management of this patient with a lung abscess is: [center][/center] [center][/center] [size=20px]A change intravenous antibiotics. B continue current antibiotic r…

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A 17-month old previously healthy girl has 6 days of cough and fever. She is mildly tachypneic, but has no increased respiratory effort, and her oxygen saturation is 99% on room air. Blood pressure and heart rate are normal. Breath sounds are decreased in the right upper lung zones, but the remainder of the physical examination is normal. A chest x-ray and CT are shown. What is your suspicion and how would you treat her?

[size=20px]You are asked to see a 5 year-old boy in the emergency department with persistent fevers despite 4 days of oral amoxicillin for community-acquired pneumonia. Temperature is 39.2 degrees, heart rate is 132/min, blood pressure is 92/67, respiratory rate is 32, and oxygen saturation is 93% on room air. He appears alert but flushed. There are decreased breath sounds in the right chest. Chest x-ray demonstrates a moderate-sized right pleural effusion. Chest ultrasound shows a right pleural effusion with internal septations. The recommended treatment strategy for this condition is: A Percutaneous chest tube insertion B Percutaneous chest tube insertion and intr…

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