Published in:
01-09-2013 | Imaging in Intensive Care Medicine
Purulent vomica from subdiaphragmatic origin
Published in: Intensive Care Medicine | Issue 9/2013
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A 71-year-old man was admitted to our medical intensive care unit for acute respiratory failure (ARF). Two months earlier, he had a right hepatectomy for hepatocellular carcinoma. A community-acquired pneumonia was suspected and the patient received antibiotics and high flow nasal oxygen therapy. A few hours later, ARF worsened owing to an episode of purulent vomica which led to non-invasive and subsequent invasive mechanical ventilation. Chest radiography (Fig. 1) and CT scan (Fig. 2) showed an air cavity in the hepatectomy compartment with a transdiaphragmatic fistula opened into the bronchopulmonary parenchyma and the right pleural cavity.
Fig. 1
Post-intubation chest radiography showing air beneath the right hemidiaphragm (arrows)
Fig. 2
CT scan showing the transdiaphragmatic fistula aperture (arrow)
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