Pseudomonas thoracic empyema secondary to nosocomial rhinosinusitis.

Three cases of Pseudomonas thoracic empyema occurring in nasotracheally intubated patients are reported. Paranasal rhinosinusitis, a well documented complication of prolonged nasotracheal intubation, could be the primary infectious location. Massive respiratory tract colonization leads to extensive necrotizing pulmonary lesions. Failure of diagnosis and treatment of sinus involvement could be responsible for persistent or recurrent pleural empyema. Treatment includes continuous pleural drainage, sinusitis treatment and antibiotics. This complication should be considered in the choice between early tracheostomy and prolonged nasotracheal intubation in Intensive Care Unit (ICU) patients.