Pyopneumothorax could arise as a progression of either underlying hydropneumothorax or empyema. Therefore, etiological agents that cause these conditions could also play a role in the evolution of pyopneumothorax [1].

Symptoms of pyopneumothorax overlap with the symptoms seen in any severe lung infection and correlate with the degree of lung collapse on the ipsilateral side. Patients may present with pleuritic chest pain, severe cough and dyspnea, whilst also manifesting certain nonspecific symptoms such as fever, loss of appetite, loss of weight, and night sweats.

A recent history of pneumonia, pleural drainage, or penetrating injury may also be suggestive of the diagnosis [2] [3].

A variety of risk factors predisposing to pleural effusion or empyema that may progress to pyopneumothorax have been identified. Some of these predisposing factors are chronic lung disease, gastrointestinal reflux, and immunosuppression. Laboratory findings such as platelets >400 X 10*9, albumin < 30 g/L, sodium < 130 mmol/L and C-reactive protein >100 mg/L, and a history of either alcohol or drug abuse, suggests an increased risk of purulent pleural complications in patients admitted for community-acquired pneumonia [4].

Physical examination may reveal tachypnea, egophony, a dull note on percussion, decreased or absent breath sounds, rales, and rhonchi [5].

• Fever

  The presence of fever may mandate a blood culture. Chest radiography is of prime importance for the differential diagnosis of pneumonia, pulmonary abscess, and empyema. [symptoma.com]

  On physical examination fever (39.2°C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. [tandfonline.com]

  We report an unusual complication of chronic foreign body aspiration--pyopneumothorax--in a 52-year-old patient presenting with productive cough and intermittent fever for more than 3 months. [ncbi.nlm.nih.gov]

  The patient usually presents with chest pain and fever. Cough and breathing difficulty may be present. [radiopaedia.org]

• Intermittent Fever

  We report an unusual complication of chronic foreign body aspiration--pyopneumothorax--in a 52-year-old patient presenting with productive cough and intermittent fever for more than 3 months. [ncbi.nlm.nih.gov]

• Splenectomy

  A 68-year-old man who had undergone total gastrectomy with splenectomy for gastric cancer and was receiving chemotherapy for esophageal cancer was presented to our hospital with dyspnea. [ncbi.nlm.nih.gov]

• Pleural Disorder

  Pleural effusions are the most common pleural disorders arising from a wide spectrum of pathologies. [apamedcentral.org]

• Abdominal Pain

  This underscores that pleural effusion associated with acute abdominal pain may reveal the existence of a communication of this type, and requires surgical management. The full text of this article is available in PDF format. [em-consulte.com]

• Eruptions

  […] troop, thorp, aport, parto, porta, aroph, pharo, phora, penup, prepn, nappe, upper, pupae, appet, paper, rappe, appmt, pneum, perun, prune, enapt, paten, penta, tapen, phren, phane, arpen, paren, prunt, punta, unapt, untap, unhap, petum, erump, pumex, erupt [myanagram.com]

• Ulcer

  The object of this report is to present a hitherto unreported association of concomitant pleural effusion and acute infectious abdominal disease, due to perforated duodenal ulcer. [em-consulte.com]

Laboratory and imaging techniques can be used to confirm the diagnosis. Leucocytosis is seen on a complete blood count, with the differential count suggestive of a left shift. Sputum should be collected in order to identify the etiological agent and to exclude tuberculosis. Antibiotic sensitivity testing should further be done on these samples. The presence of fever may mandate a blood culture.

Chest radiography is of prime importance for the differential diagnosis of pneumonia, pulmonary abscess, and empyema. An accurate diagnosis decides the course of future therapy, with pneumonia and lung abscess being treated with antibiotics, while empyema requires surgical evacuation of the pleural cavity [6] [7]. On a chest X-ray, lung abscess usually appears as a single round density with an air-fluid level. The empyema is characterized by the presence of an air-fluid level that extends to the chest wall. This is accompanied by the blunting of the costophrenic angle. Radiography in the lateral decubitus position may help determine whether the pleural collection is mobile or localized.

Chest CT should be performed when the clinical signs are characteristic for lung/pleural infection but the chest radiography is negative. Such a situation may be encountered in patients with immunosuppression. However, a CT-scan should be avoided in children due to the potential risks associated with excessive radiation exposure at a young age [8].

A Doppler ultrasonography may help distinguish a peripheral abscess from empyema by the presence of blood vessels in the tissue surrounding the abscess [9]. An ultrasonography control is needed during needle aspiration and drainage of the pleural cavity to avoid potential complications [10].

Pleural fluid obtained through diagnostic thoracentesis may reveal findings suggestive of an empyema. These pleural fluid characteristics include a purulent character of the fluid, elevated neutrophils, pleural fluid glucose levels < 60 mg/dl, lactate dehydrogenase >1000 IU/ml and the presence of microorganisms on pleural culture.

• Clostridium Perfringens

  Five patients developed pleural empyema due to Clostridium perfringens in the absence of penetration of the thorax; two of the patients presented with pyopneumothorax. Thirteen additional cases from the literature are reviewed. [ncbi.nlm.nih.gov]

The different treatment modalities of pyopneumothorax- Study of 50 cases. International Journal of Medical Science and Public Health. 2013 ; 2(3): 609-912. [imsear.li.mahidol.ac.th]

The first treatment was inadequate, but air leakage was stopped after the second treatment. However, as prolonged purulent discharge was observed, thoracic drainage was continued. [hindawi.com]

CASE REPORT A 74 years old man, with mild asbestosis, underwent treatment with methotrexate then leflunomide (LEF) for seropositive RA. [unboundmedicine.com]

Tuberculosis pyopneumothorax is a clinical event, which leads to severe complications and a set of treatment challenges. [erj.ersjournals.com]

TB 2 1993 [The prognosis of the course of pleural empyema and pyopneumothorax]. PT [allie.dbcls.jp]

Treatment and prognosis Large collections require intercostal drainage with antibiotics. [radiopaedia.org]

Tuberculous pneumothorax is a severe pathology which requires other anti tuberculor drugs eventually surgical treatment for drainage and lung decortications to improve their prognosis. Tuberculosis - management Pleura Public health © 2013 ERS [erj.ersjournals.com]

However, regarding prognosis, patients with NTM and RA complications have a 5-year survival rate of 66.1%, which is lower than that of NTM alone [7]. [hindawi.com]

Therefore, etiological agents that cause these conditions could also play a role in the evolution of pyopneumothorax. [symptoma.com]

The mycobacterium tuberculosis was the most common etiological factor. The best modality of treatment was intercostal drainage by tube with antibiotic coverage. Conclusion: Tuberculosis is main etiology in country like India. [imsear.li.mahidol.ac.th]

"An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations". Clinical Infectious Diseases. 34 (4): 434–40. doi : 10.1086/338460. [en.wikipedia.org]

In epidemiological studies on NTM in the United States, the incidence of NTM in patients with RA was 19.2 per 105 patient-years. [hindawi.com]

Varieties of coccidioidal infection in relation to the epidemiology and control of the disease. Am J Public Health 1946;36:1394-1402. 8. Batra P. Pulmonary coccidioidomycosis. J Thorac Imaging 1992;7:29-38. 9. Scully RE, Mark EJ, McNeely WF, et al. [thefreelibrary.com]

Much of the data concerning the epidemiology of LAM and associated pneumothorax is derived from case series. The incidence of pneumothorax in LAM is very high, with reported rates between 39-76%. [jtd.amegroups.com]

LAM is related in pathophysiology and clinical presentation to the Tuberous Sclerosis Complex (TSC) syndrome. [jtd.amegroups.com]

Knowing that a tension pneumothorax can occur with esophageal rupture can help prevent misdiagnosis. [ncbi.nlm.nih.gov]

Prevention of mucus plug formation and removing secretions by the above measures probably prevented in having another episode of pneumothorax in our child. [ijaweb.org]

This prevents your lung from expanding properly when you try to breathe in, causing shortness of breath and chest pain. [northshore.org]

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