Bilateral massive empyema with bronchopleural fistula

A 51-year-old Japanese man with a history of temporal lobe epilepsy, schizophrenia and multiple dental caries was admitted to a hospital with fever and dyspnea. He had a wet cough over the last month. Chest CT showed bilateral, large, thick-walled cavitary lesions that contained air-fluid levels (figure 1A), indicating a complex bronchopleural fistula and associated empyema. Chest tubes were placed, and a large amount of greenish-white pus was...