Figure 1.

Post-oesophagectomy with fever. Chest CT done on POD 17 (a) Axial non-contrast CT chest reveals tiny pockets of gas (arrow) close to proximal anastomosis which was initially attributed to normal postoperative appearance. (b) Right-sided multiloculated pleural effusion was suspicious for empyema vs chylous leak. (c) Subsequent UGI study on POD 18 identified presence of an anastomotic leak, and hence, the effusion was likely an empyema secondary to underlying leak (arrow). Teaching point: chest CT without oral contrast is inadequate for evaluation of anastomotic leak. UGI, upper gastrointestinal. POD, post-operative day.