Late onset postpneumonectomy empyema presenting 24 years after pneumonectomy

Empyema is a devastating complication that is rarely seen in the postpneumonectomy setting. A 56-year-old man presented to us 24 years after pneumonectomy with a 15 days history of chest pain and shortness of breath. Physical examination revealed a fluctuant swelling at the thoracotomy site. Computed tomography scan showed a large fluid density mass in the left pneumonectomy space. Needle aspiration and video assisted thoracoscopic surgery was carried out and culture of the aspirated fluid grew Pseudomonas aeruginosa. The patient was discharged with the chest tubes in place. At 2 months follow-up, the patient presented with fever and continuous copious drainage of pus from empyema tubes. Piperacillin with tazobactam at 4.5 grams per day helped in the resolution of fever but the output from the empyema tubes continued. An open window thoracostomy was performed and the patient was discharged on standard dosage of cefixime and fusidic acid. Following this antibiotic regimen, he remained stable with complete resolution of the infection.