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The differentiation between an empyema and a peripheral lung abscess is really difficult. The authors have summarized most points on differentiation. We had of a similar case, which looked like an Abscess on Chest Xray and had Acute angulation with lungs on Chest Ct, but due to the smooth inner walls and enhancement of pleura, we treated the case like an Empyema. Interestingly the initial CT showed some volume loss with ribs appearing crowded and this feature was more pronounced in the subsequent CT done after 2 weeks. Thus, associated volume loss with rib crowding could also be an additional point in the differentiation favoring Empyema and this volume loss might appear fairly early as well.
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