Hirshberg B, Shapira M Y, Grinblat I, Shustin L, Caraco Y
Division of Medicine, Hadassah University Hospital, Jerusalem, Israel.
South Med J. 2000 Jan;93(1):80-2.
Delayed postpneumonectomy empyema is uncommon. The condition is usually elusive and diagnosed late in the course of the disease, leading to increased morbidity. New air-fluid level on chest x-ray film or appearance of empyema necessitatis may enhance the index of suspicion and lead to early diagnosis, but in many cases no clinical or laboratory clues are apparent. We describe the case of a 60-year-old man with high fever and dyspnea 3(1/2) years after pneumonectomy. Diagnosis of postpneumonectomy empyema was delayed and finally suggested by the lack of expected mediastinal shift on chest film. Computed tomography (CT) of the chest showed a large quantity of fluid, which later proved to be empyema. The patient was treated successfully by continuous cavity irrigation with neomycin and systemic antibiotics. We conclude that in postpneumonectomy patients with septic fever, the only clue to diagnosis of delayed postpneumonectomy empyema may be hemithorax opacification without mediastinal shift, confirmed by CT-guided thoracocentesis. Therapy with cavity irrigation and systemic antibiotics seems appropriate.
肺切除术后延迟性脓胸并不常见。这种情况通常难以捉摸，在疾病过程中诊断较晚，导致发病率增加。胸部X光片上新出现的气液平面或脓胸穿破胸壁形成的寒性脓肿表现可能会提高怀疑指数并导致早期诊断，但在许多情况下，没有明显的临床或实验室线索。我们描述了一例60岁男性在肺切除术后3年半出现高热和呼吸困难的病例。肺切除术后脓胸的诊断被延迟，最终胸部X光片上缺乏预期的纵隔移位提示了该病。胸部计算机断层扫描（CT）显示有大量液体，后来证实为脓胸。该患者通过用新霉素持续胸腔冲洗和全身使用抗生素成功治愈。我们得出结论，在肺切除术后出现败血症发热的患者中，诊断延迟性肺切除术后脓胸的唯一线索可能是患侧胸腔致密影且无纵隔移位，通过CT引导下胸腔穿刺术得以证实。胸腔冲洗和全身使用抗生素的治疗似乎是合适的。
