CTICasesExplosive Pleuritis (Streptococcus anginosus Empyema)
Imaging findings
Chest CT demonstrates a low-attenuation right lower lobe lung lesion. Following a CT-guided needle biopsy of the lesion, follow-up imaging reveals the rapid development of a massive, loculated right pleural effusion within 24 hours of the procedure. Pleural fluid aspiration yields purulent fluid positive for Streptococcus anginosus without malignant cells, and the effusion is subsequently managed with chest tube drainage.
Key takeaways
Explosive pleuritis is a rare, highly rapid-onset pleural infection that typically develops within 24 hours of an invasive procedure or lung abscess rupture, frequently involving the majority of the hemithorax and showing early loculation. Direct instrumentation or biopsy of low-attenuation lung lesions suspected of being abscesses should be avoided when possible to prevent direct seeding of the pleural space, empyema, or bronchopleural fistulas.
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