There is little use for barium in this instance, in my opinion. The mass appears to be pleural based. The long length of pleural thickening cephalad to the main mass as well as the angular margin cephalad to the main mass in combination with the lack of associated rib abnormalities (e.g. erosion, fracture, abnormal spacing between the ribs, etc), and statistics, favor fluid in the pleural space, likely loculated, and I would consider empyema (pus between the lung and chest wall) most likely. Blood (hemothorax) is also possible but a bit less likely. Solid masses aren't impossible but also less likely.
Barium could play a role down the line in that esophageal perforation is a potential cause for empyema, and barium can show this, but I would only do a barium study to look for esophageal perforation if you not only first proved empyema, but also if the empyema recurred despite drainage and good antibiotic coverage.
Reply With Quote