Q: 44 year old male with HIV is transferred from floor with respiratory failure on fourth day of hospitalization. Patient CT scan of chest has been done. Report reads: "moderate pleural effusion with thickened parietal pleura". What would be your concern?


Answer: Empyema 

In emypyema bacteria quickly get  cleared from the pleural space but there is a deposition of a dense layer of fibrin on pleurae. Thickened pleura with parapneumonic effusion is highly suggestive of empyema.



 Reference: 

 Waite RJ, Carbonneau RJ, Balikian JP, et al. Parietal pleural changes in empyema: appearances at CT. Radiology 1990; 175:145.