Abstract
A 59-year-old woman presented with back pain, general fatigue, and abdominal pain. Chest X-ray and computed tomographic scan showed a severe mediastinal shift to the right with a large amount of fluid and gas collection in the left pleural cavity. Laboratory examination revealed leukocytosis (24,570/mm3) and C-reactive protein elevation (33.3mg/dl). Under the diagnosis of pyothorax with fistula, pleural drainage and curettage were performed through a left lateral thoracotomy. At the opening of the parietal pleura, gas with a stool-like odor was emitted and coffee-milk-like purulent pleural effusion was present in the left pleural cavity. Bacterial culture revealed gram-negative anaerobic bacillus. The left pleural cavity had been left open for 3 days after the first operation to control the anaerobic bacterial infection. The postoperative course was uneventful. No recurrent pyothorax was found 9 months after the operation.
