A proposed new nomenclature in clinical diagnosis from an old culprit: Empyema Thoracis Abdominis

Abstract

Introduction

We report a unique case of blunt torso trauma resulting from repeated punches during a fight, which caused right hemidiaphragmatic rupture complicated by empyema involving both the thoracic and abdominal cavities. To describe this unusual pathological communication, we propose the term empyema thoracisabdominis.

Case Report

A patient who sustained blunt abdominal trauma from repeated punches during a fight resulting in right diaphragmatic rupture is presented. Clinical findings, laboratory investigations, imaging studies, operative findings, and postoperative observations were reviewed from the patient's case records. The diagnosis of empyema communicating between the thoracic and abdominal cavities was established from the combined clinical and intraoperative findings.

An unusual abdominal asymmetry was observed, characterised by distension of the upper abdomen above the umbilicus while the lower abdomen remained relatively flat. Operative findings demonstrated empyema extending between the thoracic and abdominal cavities through a traumatic rupture of the right hemidiaphragm.

Conclusion

This case demonstrates an unusual communication of empyema between the thoracic and abdominal cavities through a traumatic diaphragmatic rupture. Based on the Greek derivation of the word empyema and the anatomical distribution observed in this patient, the descriptive term empyema thoracisabdominis is proposed.