45 yr old male with h/o binge drinking Presented with chest pain and breathlessness after multiple episodes of vomiting post binge. Xray s/o pneumothorax lft sided. Urgent ICD insertion was done. Now pt presents 14 days later with pus in the ICD and lft pyothorax. Further management??



Agree with Dr ankita Remove ICDT as early as possible and keep on antibiotics Now patient needs CECT Thorax/ full work up including Tubercular investigations Plan for VATS/ open thoracotomy

I have one query. Why did patient need left sided ICD insitu for 14 days, for a pneumothorax? Was there any air leak in the ICD? OR is it that the pneumothorax did not resolve till 2 weeks of ICD placement? Pyothorax can be due to ascending infection through ICD site. Needs culture sentivity and step up antibiotics. Repeat USG chest for any undrained pockets or any adhesions/ loculations to plan further management. In the form of only percutaneous drainage- addition ICD/ Pigtail placement, and if partially/ completely organised undrainable collection needing thoractomy/VATS drainage/ decortication. Need to rule out TB as well. Can u see any pre existing lesion/s in the lung parenchyma? Not visible in this scan, not able to zoom in.

I agree

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