Chronic pleural empyema – a clinical case-report

Abstract

A 57-year-old male patient was observed in Pulido Valente’s Hospital Rapid Diagnostic
Oncology Clinic, in 1999, with complaints of intermittent dysphagia, foetid halitosis and
thoracic pain. He had a history of pleuropulmonary tuberculosis when he was 12-years-old,
from which chest wall sequelae resulted and he had multiple hospital admissions with
pulmonary infections. He was admitted for study, and chest x-rays (CXR) showed the
presence of chest-wall lesions and a right pleural effusion. Laboratory analysis of the
pleural aspirate revealed an empyema. Upper digestive endoscopy showed a fistula, with
drainage of purulent liquid. CXR and thoracic CT scan with oral contrast documented the
passage of contrast from the oesophagus into the pleural space, confirming the existence of a oesophago-pleural fistula.
The patient underwent oesophageal exclusion surgery, with drainage and decortication of
the right pleural space. Two months later oesophagectomy and gastric tube reconstruction
was performed. Two years after surgery a relapse of the empyema occurred, and
thoracoplasty was necessary. To date there have been no subsequent problems.