9/7/2023 0 Comments How to use a bongThe patient was treated with a total 42 days of intravenous (i.v.) ceftazidime as he declined surgical intervention (pleural decortication with or without lobectomy), which was advised on Day 10 of treatment in view of non‐resolving fever and persistent drainage of pus. ![]() (B) Erect Posteroanterior (PA) view chest radiograph of patient during outpatient review showed non‐expanding “trapped” lung with thickened pleural. (A) Computed tomography (CT) thorax (axial) image under soft tissue setting showed area of necrotizing pneumonia involving left upper lobe with chest tube in‐situ. aeruginosa, which demonstrated sensitivity towards meropenem, ceftazidime, gentamicin, and amikacin. Cultures obtained from the patient’s sputum sample, pleural fluid, and water pipe grew P. Pleural empyema indices were exudative, and neutrophils were predominant with a protein ratio of 0.92 and glucose 0.3 mmol/L. Laboratory studies demonstrated leucopenia (white blood cells (WBC): 3.6 × 10 9/L absolute neutrophil count (ANC): 3.3 × 10 9/L), urea 8.6 mmol/L,C‐reactive protein 30 mg/dL, and procalcitonin of 19.03 ng/mL. A left‐sided chest drain was inserted, and thoracentesis was consistent with empyema thoracis. Bedside ultrasound demonstrated the presence of a left‐sided pleural effusion. A computed tomographic (CT) thorax showed left upper lobe NP with residual hydropneumothorax (Figs. ![]() (B) Computed tomography (CT) thorax (coronal) image under lung tissue setting showed area of necrotizing pneumonia with apical pneumothorax.Įxamination revealed crepitations with decreased breath sounds on the left lung. ![]() (A) A water pipe or “bong” used by the patient.
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