Pleural empyema physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

On examination, the following findings may be seen:[1][2][3] lateral chest wall swelling and tenderness, clubbing of the fingernails, dull percussion note, reduced breath sounds on the affected side of the chest, egophony, coarse crackles, increased fremitus, mediastinal shift to opposite side with large empyema

Physical Examination

On examination, the following findings may be seen:[1][2][3]

  • Lateral chest wall swelling and tenderness.
  • Clubbing of the fingernails
  • Dull percussion note
  • Reduced breath sounds on the affected side of the chest.
  • Egophony
  • Coarse crackles
  • Increased fremitus
  • Mediastinal shift to opposite side with large empyema

The above physical examination findings may be absent in some cases making the use of imaging studies an important component of diagnosis.


References

  1. 1.0 1.1 Atay S, Banki F, Floyd C (2016). "Empyema necessitans caused by actinomycosis: A case report". Int J Surg Case Rep. 23: 182–5. doi:10.1016/j.ijscr.2016.04.005. PMC 5022073. PMID 27180228.
  2. 2.0 2.1 Gomes MM, Alves M, Correia JB, Santos L (2013). "Empyema necessitans: very late complication of pulmonary tuberculosis". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-202072. PMC 3863066. PMID 24326441.
  3. 3.0 3.1 Kuan YC, How SH, Yeen WC, Ng TH, Fauzi AR (2011). "Empyema thoracis complicated by pneumothorax necessitans manifesting as lobulated, localized subcutaneous emphysematous swellings". Ann Thorac Surg. 91 (6): 1969–71. doi:10.1016/j.athoracsur.2010.11.075. PMID 21619994.


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