CTICasesMediastinal Abscess with Bronchopleural Fistula and Empyema
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Imaging findings
Initial haziness in the mediastinum progressed to a full-on mediastinal abscess with presumed gas-forming organisms. Subsequent development of a pleural effusion and empyema. Later, subtle evidence of a potential defect near the pleura by the bronchus intermedius, which progressed to a frank absence of the posterior wall of the bronchus intermedius. The mediastinal abscess decompressed into the pleural space.
Key takeaways
This case illustrates the progression of an untreated mediastinal abscess, leading to empyema and eventually a bronchopleural fistula. The delay in surgical intervention led to severe complications, including destruction of the bronchial wall. Mediastinal abscesses are not commonly seen, and the development of a bronchopleural fistula highlights the critical need for timely management.
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