Pediatric Pleural Empyema

  • Etiology: infected fluid (pus) in pleural space
  • Imaging: nonspherical in shape, displaces lung, +/- loculated, split pleura sign (sign of fluid in pleural space), obtuse angles to chest wall, thickened pleura, enhancing rim sign (sign of pleural inflammation due to empyema)
  • US: loculated pleural fluid
  • DDX: lung abscess

Radiology Cases of Pleural Empyema

CXR and CT of pleural empyema
CXR PA and lateral shows complete opacification of the left hemithorax causing tracheal and mediastinal shift to the right, which is seen on the axial CT with contrast of the chest to be due to a large pleural fluid collection with an enhancing pleura causing near complete left lung atelectasis.
CXR and CT of subpulmonic pleural effusion and empyema
CXR AP (above) shows a right lower lobe infiltrate and elevation of the right hemidiaphragm and lateralization of its apex. Coronal 2D reconstruction from CT with contrast of the chest (below) shows a loculated fluid collection between the inferior border of the right lung and the right hemidiaphragm.
CXR and CT of pediatric pleural empyema
CXR (above left) shows near complete opacification of the right hemithorax with no evidence of mediastinal shift. Coronal (above right) and axial (below) CT with contrast of the chest shows a large right pleural fluid collection that has multiple loculations within it which is causing complete collapse of the right lung.