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Updated: Jun 18, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
[Diagnosis and treatment of parapneumonic effusions--case 10/2009]
Jürgen Hetzel1, Marius Horger, Werner Spengler
1Abteilung für Onkologie, Hämatologie, Klinische Immunologie, Rheumatologie und Pulmologie, Medizinische Universitätsklinik Tübingen. juergen.hetzel@med.uni-tuebingen.de
History And Admission Findings:
We report on a 47-year-old male patient who was admitted for exercise-induced dyspnea and easy fatigability. Physical examination revealed reduced breath and percussion sounds of the left basal lung.
Investigations:
Laboratory investigations revealed leucocytosis and elevated C-reactive protein levels. Chest X-ray showed an area of increased opacity of the left lower hemithorax. Computed tomography (CT) confirmed an encapsulated, septated pleural effusion. The aspirate was purulent with abundant neutrophil granulocytes and a pH value of 7.1.
Diagnosis, Treatment And Course:
A diagnosis of left-sided pleural empyema was made, most probably following pneumonia. Antibiotic treatment with amoxicillin and clavulan acid was initiated and after insertion of a chest drain pleural irrigation with daily 200,000 I.U. streptokinase was performed for five days. The drainage was removed after ten days and after four months CT showed a complete remission of the lef-sided pleural empyema.
Conclusions:
Parapneumonic effusions are frequent with broad clinical range from trivial to life-threatening. Therapy decision is based on the characteristics of the effusion and the patient's clinical status and should be made within an interdisciplinary cooperation between internists and (thoracic) surgeons.
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