Pleural empyema with late evolution and the importance of early surgical evaluation: A case report

Abstract text (incl. references and figure legends)

Case history: A 55-year-old male, obese, hypertensive, alcoholic, went to the emergency service due to ventilator chest pain, chills, cough and dyspnea that had been progressing for one month. He reported crushing trauma from a fall of a desk on his chest. Clinical findings: He was evaluated by the general surgery team and was tachycardic, tachypneic, no vesicular murmurs in the left hemithorax, but present on the right. Investigation/Results: Previous chest X-ray: ribs fracture on the right. New chest X-ray: left pleural effusion with visible air-fluid level. Chest and total abdomen contrast-enhanced tomography: large pleural effusion on the left, air-fluid levels, probable pleural empyema. Diagnosis: Post-traumatic pleural empyema. Therapy and Progressions: Antibiotic therapy was started. Left chest drainage was performed, without complications. The material collected was sent for bacteriological analysis, whose results showed positive bacterioscopy for gram-positive cocci (viridans group streptococci) and negative BAAR research. The paciente stayed in the intensive care unit for 24 hours and had a good clinical evolution. He was treated in the ward with subsequent pleuroscopy and pulmonary decortication and was discharged from the hospital with a scheduled outpatient return. Comments: Post-traumatic empyema without penetrating injury is rare, severe and with high morbidity and mortality. Thus, the analysis of the clinical history, physical examination and imaging tests associated with the follow-up of the patient by an experienced surgeon are essential for successful treatment and better prognosis. References: Arsenijević, M. et al. PLEURAL EMPYEMA MENAGEMENTE: BRIEF REVIEW OF LITTERATURE. Ser J Exp Clin Res 2021; Dogrul, B. N. et al. Blunt trauma related chest wall and pulmonary injuries: An overview. CJT. vol. 23,3 2020; Kim, et al. Chest Trauma: Current Recommendations for Rib Fractures, Pneumothorax, and Other Injuries. Curr. Anesthesiol. Rep. vol. 10,1 2020.

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