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Ann Thorac Surg 2002;74:935
© 2002 The Society of Thoracic Surgeons

Images in cardiothoracic surgery

Unusual imaging of late postpneumonectomy empyema

Marco Alifano, MD*a, Pierre Magdeleinat, MDa, Jean-François Regnard, MDa

a Service de Chirurgie Thoracique, Hôtel-Dieu, Paris, France

* Address reprint requests to Dr Alifano, Unitè de Chirurgie Thoracique, Hôtel-Dieu, 1, Place du Parvis Nôtre-Dame, 75181 Paris Cedex 04, France
e-mail: marcoalifano{at}yahoo.com

An 83-year-old woman presented with a left-sided thoracic empyema necessitatis occurring 38 years after a left extrapleural pneumonectomy for tuberculosis.

Chest roentgenogram was extremely unusual. Very marked hyperinflation and herniation of the right lung simulated the presence of ventilating left lung parenchyma (Fig 1). Thoracic computed tomography scan confirmed these findings and showed the presence of a very small postpneumonectomy space (Fig 2). The exeresis of the entire pleura at the time of pneumonectomy is probably responsible for these changes, thus explaining the absence of the usual appearance of completely opaque and retracted hemithorax. At computed tomography scan, the empyema necessitatis was also evident (Fig 2).



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  		Fig 1.
 


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  		Fig 2.
 
Treatment involved open-window thoracostomy with debridement of the superficial abscess. Culture of operative specimens grew Mycobacterium tuberculosis. Antituberculosis chemotherapy was also administered. A completely favorable outcome was observed.





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