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.