Empyema Thoracis Complicated by Pneumothorax Necessitans Manifesting as Lobulated, Localized Subcutaneous Emphysematous Swellings Yeh Chunn Kuan, MRCP,

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Empyema Thoracis Complicated by Pneumothorax Necessitans Manifesting as Lobulated, Localized Subcutaneous Emphysematous Swellings Yeh Chunn Kuan, MRCP, Soon Hin How, MMED, Wing Choy Yeen, MD, FACS, Teck Han Ng, MRCP, Abdul Rani Fauzi, FRCP The Annals of Thoracic Surgery Volume 91, Issue 6, Pages 1969-1971 (June 2011) DOI: 10.1016/j.athoracsur.2010.11.075 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Plain chest roentgenogram shows a left, upper zone, pleural-based lesion (inset) and a globular heart. The Annals of Thoracic Surgery 2011 91, 1969-1971DOI: (10.1016/j.athoracsur.2010.11.075) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The patient's preoperative findings showed lobulated and localized subcutaneous emphysematous swellings of the chest wall (left), axilla (bottom right), and supraclavicular fossa (top right). The Annals of Thoracic Surgery 2011 91, 1969-1971DOI: (10.1016/j.athoracsur.2010.11.075) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Coronal (left) and axial (right) views of the computed tomographic scan of the thorax show a lobulated, left upper lobe pneumothorax communicating with subcutaneous air-filled collections. The Annals of Thoracic Surgery 2011 91, 1969-1971DOI: (10.1016/j.athoracsur.2010.11.075) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Intraoperative finding (arrowhead points to the bronchopleural fistula). The entire raw surface is the compressed left upper lobe apex. The Annals of Thoracic Surgery 2011 91, 1969-1971DOI: (10.1016/j.athoracsur.2010.11.075) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The patient's postoperative findings show a resolution of the lobulated, localized subcutaneous emphysematous swellings. Anterior (left) and posterior (right) views. The Annals of Thoracic Surgery 2011 91, 1969-1971DOI: (10.1016/j.athoracsur.2010.11.075) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions