A case of tension pyothorax with septic shock.

Dear Editor,

A 68-year-old male called an ambulance because of left chest pain and dyspnea for 2 days. He had diabetes mellitus, alcoholic hepatitis and interstitial pneumonia treating with a steroid. After checking physical examinations, his blood pressure suddenly decreased 50/36 mmHg. A chest roentgenogram revealed decreased radiolucency of the left thoracic cavity with a right shift of the mediastinum [Figure 1]. An emergency thoracic fluid drainage was executed [Figure 2], and the blood pressure increased up to 94/60 mmHg. The results of a gas analysis of the pleural fluid were compatible with a pyothorax. He was treated in the intensive care unit and discharged alive. This case is the third case report of a pure tension pyothorax.[12] All of these cases were immunocompromised hosts, massive fluid production from infected pleura or pneumonia might have been the cause of the tension state. Urgent appropriate drainage is necessary, or this situation can lead to death.

Figure 1

The first chest roentgenogram the chest roentgenogram revealed decreased radiolucency of the left thoracic cavity with a right shift of the mediastinum

Figure 2

The second chest roentgenogram the chest roentgenogram showed improvement of the radiolucency of the left lung field and the shift of the mediastinum