Pleural empyema: a case of failing to see the discharge leading to discharge failure

A 54-year-old heavy smoker was admitted with a 2-week history of pleuritic chest pain, cough, shortness of breath and weight loss. He had not improved despite a course of antibiotics from his general practitioner. He was commenced on intravenous antibiotics for presumed pneumonia based on his chest X-ray, which seemed to show left middle zone opacification (figure 1), and after 2 days, he was discharged with a further oral antibiotic course. Figure 1Posteroanterior chest X-ray showing pleural-based shadowing with cavitation abutting the left lateral chest wall with a characteristic convex ‘D’ shape of a pleural empyema. There is also evidence of atelectasis and tenting of the diaphragm. The patient was readmitted within 48 hours with severe sepsis. His chest X-ray on this occasion showed a left-sided partial white-out (figure 2). He had a CT chest and this showed a large left...
Source: Postgraduate Medical Journal - Category: General Medicine Authors: Tags: Journalology, General practice / family medicine, Drugs: infectious diseases, Pain (neurology), Alcohol-related disorders, Drugs misuse (including addiction), Radiology, Pneumonia (respiratory medicine), Clinical diagnostic tests, Cardiothoracic surgery, Source Type: research