History of tuberculosis, presented with chest wall mass and pain.
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A large fluid collection is seen in the L pleural cavity, with extension into the soft tissues of the chest wall, compatible with empyema necessitatis. Speckles of calcification is seen within the collection. Active contrast extravasation is seen in the intercostal region.
Empyema necessitans is a rare complication of empyema with extension of the fluid collection and infection to the subcutaneous soft tissue. The most common cause of empyema necessitatis is Mycobacterial infection, as in our patient. Less common causes include actinomyces, streptococus and staphylococcus infection.
This case also demonstrates erosion of intercostal artery as a complication of empyema necessitatis. The patient was subsequently treated with with arterial embolisation.