Discussion
Thoracic drainage through a chest tube confirmed empyema. Tachycardia and hypoxia improved with drainage of two liters of pus.Streptococcus intermedius was detected in the pleural fluid and blood cultures. After 4 weeks of antibiotic therapy with 15 days of thoracic drainage, the patient was discharged without complications.
Massive empyema can cause a mediastinal shift, diminished breath sounds, and respiratory distress, mimicking tension pneumothorax.1 Lung ultrasound and chest radiography can help differentiate between both.2 Emergency needle decompression at the second intercostal space is recommended for tension pneumothorax; however, this can cause iatrogenic pneumothorax in patients with massive empyema. (Fig. 1a: arrow). Therefore, chest imaging should be performed before such procedures.