title: [Diagnosis and treatment of parapneumonic effusions--case 10/2009].
abstract: METHODS
  We report on a 47-year-old male patient who was admitted for exercise-induced dyspnea and easy fatigability. Physical examination revealed reduced breath and percussion sounds of the left basal lung.
  
  
  METHODS
  Laboratory investigations revealed leucocytosis and elevated C-reactive protein levels. Chest X-ray showed an area of increased opacity of the left lower hemithorax. Computed tomography (CT) confirmed an encapsulated, septated pleural effusion. The aspirate was purulent with abundant neutrophil granulocytes and a pH value of 7.1.
  
  
  METHODS
  A diagnosis of left-sided pleural empyema was made, most probably following pneumonia. Antibiotic treatment with amoxicillin and clavulan acid was initiated and after insertion of a chest drain pleural irrigation with daily 200,000 I.U. streptokinase was performed for five days. The drainage was removed after ten days and after four months CT showed a complete remission of the lef-sided pleural empyema.
  
  
  CONCLUSIONS
  Parapneumonic effusions are frequent with broad clinical range from trivial to life-threatening. Therapy decision is based on the characteristics of the effusion and the patient's clinical status and should be made within an interdisciplinary cooperation between internists and (thoracic) surgeons.
authors.affiliation: Abteilung für Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen. juergen.hetzel@med.uni-tuebingen.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hetzel
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
authors.forename: Werner
authors.initials: W
authors.lastname: Spengler
authors.forename: Hermann
authors.initials: H
authors.lastname: Aebert
authors.forename: Lothar
authors.initials: L
authors.lastname: Kanz
authors.forename: Karsten
authors.initials: K
authors.lastname: Müssig
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D016724:Empyema, Pleural / Q000097:blood / Q000000981:diagnostic imaging*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007964:Leukocytosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D013300:Streptokinase / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D002097:C-Reactive Protein; D013300:Streptokinase