A 56-year-old man comes to the emergency department because of a 4-day history of fever and shortness of breath. He has a history of COPD treated with inhaled albuterol. His temperature is 39.0°C (102.2°F), pulse is 95/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows decreased breath sounds and poor air movement over the left lung. Chest radiograph shows a moderate-sized loculated pleural effusion on the left side. Ultrasonography reveals multiple separate fluid pockets within the pleural space. Chest tube placement produces only a small amount of thick pus. Which of the following is the most likely underlying mechanism for this patient's pleural effusion?

Question

A 56-year-old man comes to the emergency department because of a 4-day history of fever and shortness of breath. He has a history of COPD treated with inhaled albuterol. His temperature is 39.0°C (102.2°F), pulse is 95/min, respirations are 20/min, and blood pressure is 130/80 mm Hg. Cardiopulmonary examination shows decreased breath sounds and poor air movement over the left lung. Chest radiograph shows a moderate-sized loculated pleural effusion on the left side.  Ultrasonography reveals multiple separate fluid pockets within the pleural space.  Chest tube placement produces only a small amount of thick pus.  Which of the following is the most likely underlying mechanism for this patient's pleural effusion?

Quizplus · Accepted Answer

Eductional Objective: Empyema is an accumulation of pus within the pleural space that can result from multiple sources of bacterial contamination.  It usually represents advanced progression of a complicated parapneumonic effusion resulting from bacterial translocation from the alveoli.

A 56-Year-Old Man Comes to the Emergency Department Because of a 4-Day