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Chest Infections: Chest Infections I |

A Case of a Pleural Empyema Secondary to a Percutaneous Lung Biopsy FREE TO VIEW

Ting Cheng, MD; QiJian Cheng, PhD; HuanYing Wan, MD
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Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A107. doi:10.1016/j.chest.2016.02.112
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SESSION TITLE: Chest Infections I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Percutaneous needle biopsy of the lung is a useful tool in the evaluation of pulmonary abnormalities. However, percutaneous needle biopsy has some complications. We present a case of a pleural empyema secondary to a percutaneous lung biopsy.

CASE PRESENTATION: A 30-year-old Chinese male was admitted with a 2-week history of fever and sputum. The peak temperature was about 38.5 ℃ and the sputum had a fishiness smell. He often had toothache. The physical examination was unremarkable. Initial laboratory findings were significant for WBC 11*10^9/L, with 68% neutrophils and CRP 107mg/L. Chest CT scanning showed a patch of infiltration with ground grass density and segmental distribution, two nodular opacities in the infiltration with 1-2 centimeter in diameter and a hole in one of the nodules. Firstly, he was treated with Amoxicillin/clavulanic for 1 week. The symptoms including fever disappeared and blood cell count came to normal. The follow-up CT showed that the infiltration with ground grass density disappeared, the nodule with a hole shrinked with the hole disappeared, but the other nodule seemed a bit larger. A computed tomography guided percutaneous needle biopsy was performed successfully. However, two hours later the operation, he complained of left chest pain and dyspnea. The breath sound of left lung was low. The chest X-ray showed no pneumothorax or obvious pleural effusion. Two days later, he began to have fever, with the peak temperature of 38 ℃ and dyspnea, while the chest pain was alleviated. The WBC was 12*10^9/L, with 79% neutrophils, CRP was 7.3mg/dl and procalcitionin (PCT) was 0.45ng/ml. The chest CT showed moderate pleural effusion in left thorax and bilateral infiltration. A pleurocentesis was performed and the pleural fluid analysis showed: WBC 1.2*10^9/L, neutrophil: 89%, total protein 59g/L, LDH 840U/L, ADA 21U/L. Imipenem/cilastatin and vancomycin were initiated and a pigtail catheter was placed for drainage. His symptom resolved in 3 days. The infiltration of the contralateral lung disappeared 1 week later, and the infiltration and pleural effusion was mostly absorbed in one month.

DISCUSSION: Percutaneous needle biopsy of the lung is indispensable in diagnosing malignant tumor, special inflammation and infection. The common complications include pneumothorax and pulmonary hemorrhage. The rare but important complications include air embolism and tumor seeding1. No case has been reported about pleural empyema secondary to a percutaneous lung biopsy to the best of our knowledge. Amoxicillin/clavulanic is indicated in treating lung abscess and pneumonia2. However, the dissemination of the infection suggested that the focus was purulent and bacteria were still alive in it.

CONCLUSIONS: As our case demonstrates, pleural empyema can be a complication of percutaneous lung biopsy. Amoxicillin/clavulanic may not very effective in treating lung abscess.

Reference #1: Winokur and Pua et al., 2013

Reference #2: Yazbeck and Dahdel et al., 2014

DISCLOSURE: The following authors have nothing to disclose: Ting Cheng, QiJian Cheng, HuanYing Wan

No Product/Research Disclosure Information


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