EDITOR'S QUIZ: GI SNAPSHOT
An unusual chest infection
1 Department of Anaesthetics and Critical Care, Derby Hospital NHS Trust, Derby, UK
2 Department of Surgery, Derby Hospital NHS Trust, Derby, UK
Correspondence to:
Correspondence to:
Dr S Loganathan
Department of Anaesthetics and Critical Care, Lister Hospital, Coreys Mill Lane, Stevenage SG1 4AB, UK; sblogan@doctors.org.uk
Keywords: oesophageal perforation; chest trauma; chest drain; non-operative treatment
| The first 150 words of the full text of this article appear below. |
A 53 year old man fell down a flight of stairs. He presented to casualty complaining of shoulder and back pain. He was discharged with a diagnosis of musculoskeletal pain. Six weeks later he presented with pleuritic chest pain, dyspnoea, and indigestion. On examination he was tachypnoeic, tachycardic, febrile, and hypotensive. Chest x ray (fig 1
) demonstrated right lower lobe consolidation and a pleural effusion. He was diagnosed with sepsis secondary to pneumonia and treated with antibiotics. A chest drain was inserted and drained purulent fluid which grew Candida and therefore fluconazole was commenced. Over the next few days his condition failed to improve. Further biochemical analysis of the pleural fluid indicated the presence of triglycerides and cholesterol, raising the suspicion of a chyle leak. Repeat chest radiograph showed re-accumulation of right pleural effusion. The chest drain was resited and it drained in excess of 4 litre over 24
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Gut 2006 55: 1164.[Extract] [Full Text] [PDF]
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