Day: July 25, 2023

Toddler with respiratory distress

CXR and CT of bronchopleural fistula
CXR AP (above) shows diffuse bilateral airspace disease and a right sided pneumothorax that is almost completely drained by a right chest tube. Axial CT with contrast of the chest (below left) shows air and fluid and a chest tube in the right pleural space and an enhancing rim sign of the pleura. There is also a bronchopleural fistula from the superior segment of the right lower lobe to the necrotic lung and pleural space (below right).

The diagnosis was bronchopleural fistula and pleural empyema in a patient with streptococcus pneumonia.