Figure 1. The yellowish secretions from the patient’s left chest wall.
On examination, he was ill, tachypneic (30 breaths per minute), and
febrile, with a corrected axillary temperature of 38.9. His oxygen
saturation in room air was 90%, and his blood pressure was within
normal limits. There were multiple enlarged, tender supraclavicular and
axillary lymph nodes observed on the left side. The lymph nodes measured
approximately 0.5 cm and were found to be mobile with a firm
consistency.
On the chest examination, a visible scar from the previous chest tube
was observed on the left side of the chest. In proximity to the chest
tube scar, a fistula measuring 2 cm was detected. The tract was found to
be actively discharging yellowish, purulent drainage. In chest
auscultation, breath sounds were reduced in the left lower zone of the
lung with few crepitations. Other systemic examinations were found to be
normal.
The patient visited a physician with the mentioned complaints and was
prescribed oral therapy consisting of clindamycin capsules 150 mg four
times daily and cephalexin capsules 250 mg four times daily.
Nonetheless, due to the lack of improvement, the patient was referred to
Kerman Afzalipour Hospital for further assessment and management.
Laboratory testing revealed leukocytosis with a white blood cell count
of 17\(\times\)\(10^{3}\)per mmᶟ with a
neutrophil predominance of 80%, normocytic anemia with hemoglobin of
9.7 g/dl, a mean corposcular volume of 79 fl and a platelet count of
435\(\times\) \(10^{3}\)per mmᶟ. The initial blood sample analysis
indicated a C-reactive protein level of 112 mg/dl and an erythrocyte
sedimentation rate (ESR) of 44 mm/h.
Based on the patient’s history and physical examination, a chest
radiograph was performed to evaluate the patient’s clinical status. A
radiological investigation revealed the existence of a mass-like lesion
in the left lower lobe. A chest CT scan was remarkable for left lower
lobe cosolidation and loculated effusion, which contain air bubbles in
favor of empyema (Figure 2).