Imaging

Empyema

Preliminary Diagnosis: Empyema

I. What imaging technique is first-line for this diagnosis?

Chest X-ray, PA, and lateral view.

II. Describe the advantages and disadvantages of this technique for diagnosing empyema.

Advantages

  • Inexpensive.

  • Highly portable.

  • Exposes the patient to minimal ionizing radiation.

  • Can suggest an infectious fluid collection in the correct clinical setting.

Disadvantages

  • Less specific in defining an empyema compared to companion CT.

  • Less adept in detailing any underlying primary or secondary processes, such as a mass, pneumonia, or foreign body, compared to CT imaging.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications. May require consent for pregnant patients at some institutions.

IV. What alternative imaging techniques are available?

CT of the chest with intravenous contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing empyema.

Advantages

  • Contrasted CT of the chest is the gold standard imaging modality to evaluate for an empyema.

  • Split pleura sign noted on contrasted CT of the chest is pathognomonic for diagnosing an empyema.

  • CT imaging is more specific and sensitive in identifying any underlying primary or secondary processes, such as a mass, pneumonia, foreign body, etc.

Disadvantages

  • CT imaging exposes patients to more ionizing radiation.

  • CT imaging is less portable.

VI. What are the contraindications for the alternative imaging techniques?

May be contraindicated in pregnant patients.

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