Same patient.
chronic empyema aspiration
- Which method should be performed in order to determine whether the persisting effusion is infected?
(Click here for the answer) Puncture.
It is implemented in the prone position. We see the image turned in a supine position. The direction of the needle avoids the large vessels. It reveals protein-rich fluid, the bacteriology is negative.
Take-home message:
imaging gives no answer on persisting effusions bacteriology. Despite decades of sterility, it can be suddenly infectiously activated without giving a morphological hint.
New patient 47:
51 years ago, in 1958, this case was published in "Tuberkulose Arzt”. The author, HG Schmitt, would be 102 years old. He had first seen the patient in 1944; it was then that his interest for pleural pathology commenced:
our patient is a 38-year old man who had prolonged pleurisy in 1958, 16 years prior to the admission. The overview x-ray (in low KV-technique) shows no calcification.
Bild 47
- Which (wrong) diagnosis was probably made first?
(Click here for the answer) One suspected a neoplastic mass. Your answer is right. – The next picture shows a simple method which gives new information.
120 kV and Bucky-Potter grid demonstrate a large, homogenous, globular shadow enveloped by a calcified shell .
Bild 48
- Which investigations would we request today?
(Click here for the answer) Sonography and CT. Both did not exist at that time. It would verify a chronic, persistent effusion bordered by calcified visceral and parietal pleura.
Note the uncalcified layer between parietal pleura and the inner thoracic wall. -
In 1953 they performed the following exam:
A conventional axial tomography.
Bild 49
- What is visible?
(Click here for the answer) Spine, aorta descendens, heart shadow and the voluminous persistent effusion, which is surrounded by a calcified layer.
Radiograph of the operative specimen, demonstrating the envelope of irregular calcified connective tissue.
Bild 50
