Eddie’s chest x-ray revealed a complete opacification of the left hemithorax with to right shift of the cardiomediastinum, suggesting a large pleural effusion. The ultrasound also showed left pleural effusion with loculations, supporting the diagnosis of empyema. The computed tomography showed a left pleural effusion with loculations, left lung atelectasis, and mediastinal shift to the right. Laboratory values include a white count of 27,000, hemoglobin and hematocrit of 10.9/32.4, and platelets of 610,000. The differential was 67% polymorphonuclear leukocytes, 13 mononucler cells and the erythrocyte sedimentation rate was 101.