CHIEF COMPLAINT:

An 8 years old girl admitted at hospital in 82/01/19 with a chief complaint of fever, respiratory distress and night sweat

HOPI:

she had a history of two months of weight loss ,fever and night sweat which was under antibiotic prescription without significant improvement

She was the fourth child in the family from a mother G5P5Ab0 and  the result of a NVD without complication.

She was from afganistan and had a long contact with a patient with TB , she lived near a sheep raising, no history of hospital admission , or specific illness, vaccination history was positive.

PH. E.

T= 38 C ORAL       PR=110/Min

RR=33/MIN

BW=19KG

General appearance was good .

Head and neck=normal. No adenopathy

chest = heart sounds were normal, full dullness on left lower chest and decrease of the breath sounds was apparent .

Lab investigations:

CBC DIFF , ESR, CRP , BS , CA,ELECTROLYTES ,Urea,Creatinine U/A , U/C , B/C , ABG , ELIZA IgG AND IgM for echinococcus granulosus

Needle aspiration of fluid

CHEST X RAY , CHEST CTSCAN

Abdominal sonography

WBC =9100/mm3  poly=54%,lym=44%,Eos=1%,

mono=1%,plt=607000,ESR=123

BS,UREA,CREATININE=NL

NA,K,CA,P,=NL

CRP=3+

U/A , U/C , B/C =Neg , ABG=NL

Elisa for echinococcus IgG AND IgM=Neg

Aspiration of  fluid  results:                LDH=40,PRO=10,SUGAR=30mg/dl and smear and culture was negative

CHEST X RAY:

Homogenous opacity on left lower lobe that obscures the diaphragm and causes the shift of trachea and heart to the right ,a crecentric  shadow is seen at the top of the opacity that suggests its CYSTIC NATURE, CTscan of thorax was recommended .

CHEST CTSCAN:

In the posterior left hemi thorax there was a big cystic mass with thick layer and pleural thickness , it seems it is an encapsulated empyema.

Abdominal sonography was normal.

Other investigations:

PPD=NEG

three times gastric lavage for BK was negative 
 

        What is the patient's possible diagnosis?