Post-pneumonectomy empyema (PPE) is an uncommon but possibly life-threatening condition. It has a strong association with bronchopleural fistula (BPF), which acts as a continued source of infection into the thoracic cavity and increases mortality. We describe the case of a Brazilian Amazon man that evolved empyema caused by Escherichia coli in the thoracic cavity associated with bronchopleural fistula 19 years after pneumonectomy. This case reinforces the importance of an early suspicion of PPE to avoid diagnostic delay and improve outcomes.
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