Pneumatoceles may develop in areas of resolving consolidation. In severe cases, there may be rapid progression to pulmonary opacification and death. The usefulness of chest radiographs in management of hydrocarbon is limited by the lack of correlation between the clinical picture and radiographic findings. Most idiopathic pneumothoraces are relatively small and not associated with significant respiratory distress. Occasionally, massive tension pneumothorax results in significant respiratory compromise.
Chest radiographs are usually diagnostic.
Occasionally, CT may be necessary to evaluate for underlying abnormalities. Large parapneumonic pleural effusion complicating bacterial pneumonia may be associated with severe respiratory distress. Exudative effusions are due to inflammatory increase in vascular permeability, while empyema represents actual infection of the parapneumonic effusion. Most resolve with adequate antibiotic therapy. Chest tube drainage is occasionally necessary, while other surgical intervention is rarely indicated.