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Rebuttal From Dr Nguyen et alRebuttal From Dr Nguyen et al

Thien A. Nguyen, MD; Cesar Liendo, MD, FCCP; Michael W. Owens, MD
Author and Funding Information

From the Department of Pulmonary/Critical Care and Sleep Medicine, Louisiana State University, Health Sciences Center Shreveport.

CORRESPONDENCE TO: Michael W. Owens, MD, Louisiana State University, Health Sciences Center Shreveport, Department of Pulmonary/Critical Care and Sleep Medicine, 1501 Kings Highway, Shreveport, LA 71103; e-mail: Michael.Owens@va.gov


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1211-1212. doi:10.1378/chest.15-0095
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As stated previously, we believe spontaneous bacterial empyema (SBEM) is neither a spontaneous entity nor an empyema by classic definition. This condition is most often seen in patients with preexisting liver disease and ascites. We believe that it most often originates in the peritoneal space, where infection of ascitic fluid with infradiaphragmatic organisms leads to migration across the diaphragm to secondarily seed the pleural space. Dr Lai and colleagues1 have suggested that SBEM occurs without preexisting spontaneous bacterial peritonitis (SBP), that reduced opsonic activity of pleural fluid predisposes to the development of spontaneous infection, and that there are selected case reports of patients without cirrhosis with SBEM.

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