[Diagnosis and treatment of parapneumonic effusions--case 10/2009].
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.
Hetzel
Jürgen
J
Abteilung für Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen. juergen.hetzel@med.uni-tuebingen.de
Horger
Marius
M
Spengler
Werner
W
Aebert
Hermann
H
Kanz
Lothar
L
Müssig
Karsten
K
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
D005343:Fibrinolytic Agents; D002097:C-Reactive Protein; D013300:Streptokinase