Postpneumonectomy empyema: CT findings in six patients

Chest radiographs and CT scans, obtained in six patients with proven postpn eumonectomy empyema, were retrospectively reviewed by comparing the radiolo gic image obtained at present with that obtained before symptom onset. Conv exity or straightening of the concave mediastinal margin of the postpneumon ectomy space was identified on CT scans in all of six patients (100%), whil e contralateral mediastinal shift was noted on both radiographs and CT scan s in four patients (67%). Multiple air-fluid levels appeared equally on rad iographs and CT scans in three patients (50%). CT depicted increased thicke ning of the parietal pleura (n = 5, 83%) and the extrapleural tissues (n = 3, 50%) and empyema necessitans (n = 2, 33%), which were not apparent on ra diographs. Postpneumonectomy empyema is characterized on CT scans by revers al of the normal concavity of the mediastinal margin with increased thicken ing of the residual parietal pleura. CT is superior to radiography in asses sing the manifestations of postpneumonectomy empyema. (C) 2001 Elsevier Sci ence Inc. All rights reserved.