Question

A 70 year old woman develops pneumonia during a winter influenza outbreak. She receives antibiotics at home, and her condition improves over the next week. At that time she notes increased pain in her chest, increased cough, and recurrent fever; she is sent to the ED. You are asked to evaluate her. A CXR reveals pleural effusion in the right lung field confirmed on CT. What is the most likely diagnosis?

Answer 1

The most likely diagnosis for the elderly woman with a history of pneumonia, now experiencing increased pain, cough, and recurrent fever with pleural effusion on imaging, is complicated pneumonia or empyema.

Step-by-step explanation:

The 70-year-old woman who developed pneumonia during an influenza outbreak, received antibiotics, and then experienced a return of symptoms including a pleural effusion has a likely diagnosis of complicated pneumonia or possibly a secondary infection. The recurrence of fever, increased cough, and chest pain, combined with the imaging findings, suggest that her initial infection may have progressed or that she could have developed an empyema, which is a collection of pus in the pleural space. The chest X-ray (CXR) and computed tomography (CT) that revealed a pleural effusion are key to diagnosing her condition. Empyema often requires not only antibiotics but also drainage of the infected fluid.