• 69 year old male with a history of
  • HTN, HLD, pre-DM, COPD, s/p 1
  • pw Left-sided pleuritic chest pain.
  • left VATS with decortication and resection of
  • large bullae after
  • hydropneumothorax with empyema,
• There is extensive left-sided bulla disease with accompanying fluid collections in the left upper lobe as well as the left lower lobe. The large left upper lobe fluid collection represents fluid within a large bulla or, more likely, chronic hydropneumothorax secondary to a ruptured bulla. There is surrounding atelectasis of the lung parenchyma. There is a fluid collection in the left lower lobe, representing a loculated pleural effusion. On the right, to a much lesser extent than the left, there is bulla disease.  No mediastinal lymphadenopathy is visualized.IMPRESSION:
  1. Extensive left-sided bulla disease with a large left upper lobe fluid collection representing fluid within a large bulla or, more likely, chronic hydropneumothorax secondary to a ruptured bulla.
  2. Loculated left lower lobe pleural effusion.
  3 Multiple right-sided pulmonary nodules, the largest of which measures 6.3 mm. Short interval followup with a CT in 6 months is recommended.
  4. 3.9 cm x 3.9 cm dominant cystic lesion in the spleen. Differential diagnosis includes posttraumatic pseudocyst, lymphangioma, and, less likely, abscess.
  5. Asymmetric vocal cords. This may represent left-sided focal cord paralysis.
  6. Small to moderate sized hiatal hernia.

Subsequent s/p left VATS decortication and bullae resection