Bear Cameron, Dow Jane, Pham Andrew, Hafeez Wasif, Siddique Mohamed S
Medical Education, Wayne State University School of Medicine, Detroit, USA.
Family Medicine, Detroit Medical Center Grand River Health Center, Detroit, USA.
Cureus. 2025 Jul 9;17(7):e87599. doi: 10.7759/cureus.87599. eCollection 2025 Jul.
A 58-year-old man with a history of type 2 diabetes mellitus was hospitalized for hyperglycemia. During a review of systems, the patient reported additional symptoms of mild, right-sided pleuritic chest pain. Further investigation revealed dullness to percussion with decreased breath sounds and slight tachycardia on physical exam. Additional workup revealed a 16 cm pleural effusion on CT, despite no fever, no leukocytosis, and mild clinical presentation. Thoracentesis findings revealed empyema, and laboratory analysis identified . Chest tubes were placed and antibiotics administered during a 15-day hospital stay until the patient requested to leave against medical advice. No concerns of respiratory infection were indicated during the patient's initial admission to the emergency department, nor during the patient's previous hospitalization at a different facility one month prior. The patient remained afebrile (except for one recorded mild fever) with no leukocytosis for the entirety of the admission. This case study serves to increase awareness that even a large empyema can go undiagnosed when clinical presentation deviates from the expected and to inform physicians' response to improve patient health outcomes.
一名有2型糖尿病病史的58岁男性因高血糖住院。在系统回顾期间，患者报告了右侧轻度胸膜炎性胸痛的其他症状。进一步检查发现体格检查时叩诊呈浊音，呼吸音减弱，并有轻度心动过速。尽管没有发热、白细胞增多和临床表现轻微，但进一步检查发现CT显示有16厘米的胸腔积液。胸腔穿刺结果显示为脓胸，实验室分析确定了……。在15天的住院期间放置了胸管并给予了抗生素治疗，直到患者要求自动出院。在患者最初入住急诊科时，以及在一个月前在另一家医院住院期间，均未发现有呼吸道感染的问题。在整个住院期间，患者一直无发热（除了一次记录的低热）且无白细胞增多。本病例研究旨在提高人们的认识，即当临床表现与预期不符时，即使是大量脓胸也可能未被诊断出来，并为医生提供应对措施，以改善患者的健康结局。
