A 45-year-old male presented to the emergency department after being found unresponsive. Vitals, laboratory findings, and chest X-ray revealed concern for tension empyema. Thoracostomy was performed, and hemodynamics subsequently improved. Later, was cultured. This is the first known reported case of tension empyema.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272902PMC
http://dx.doi.org/10.7759/cureus.25853DOI Listing

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Community-Acquired Empyema Leading to Tension Physiology: A Case Report.

Clin Pract Cases Emerg Med

August 2024

Desert Regional Medical Center, Department of Emergency Medicine, Palm Springs, California.

Introduction: A tension empyema, in which purulent material accumulates in the chest cavity and leads to cardiopulmonary dysfunction, is a rare complication of empyemas. Moreover, fungal empyemas that grow and cause tension physiology have not yet been previously described.

Case Report: In this report, we present an immunocompetent 30-year-old male who presented to the emergency department with worsening shortness of breath and was found to have a left-sided fungal empyema causing tension physiology.

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Several studies indicate that observation alone is sufficient for the management of stable pneumothorax. To compare clinical efficacy, tolerability, and safety outcomes for treating hemodynamically stable adult patients with pneumothorax, the present review compared observation alone versus interventional procedures. We searched PubMed and Google Scholar from inception until June 24, 2020, for randomized controlled trials (RCTs) comparing observational therapy with conventional therapy for the treatment of adult pneumothorax.

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We present a case of a previously fit and well 28-year-old male who presented to the emergency department with respiratory distress and hypoxia four days after an alleged assault and blunt-force trauma to the chest wall. Initial clinical assessment and imaging suggested a likely diagnosis of delayed massive hemothorax associated with mediastinal shift. However, upon chest drain insertion, a large amount of pus was unexpectedly drained, leading to an immediate improvement in symptoms and restoration of mediastinal anatomy on repeat imaging.

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