Empyema necessitans

Case contributed by Vincent Tatco


Diagnosed case of pulmonary tuberculosis. Presented with a mass at the upper left quadrant of abdomen.

Patient Data

Age: 30 years old
Gender: Female

The left hemithorax is slightly contracted with diffuse nodular pleural thickening. Nodularities along the left major fissure are also seen. There are rim-enhancing locules of pleural fluid in the left lower hemithorax. These rim-enhancing fluid collections are likely empyemas. 

A lobuled, subcutaneous, rim-enhancing fluid collection is demonstrated in the left anterolateral thoraco-abdominal wall. Surrounding fat stranding, thickening of the left rectus abdominis, oblique and transversus abdominis muscles, and overlying skin thickening reflective of inflammation are noted. These findings are reflective of abscess formation probably extension of the abovementioned pleural infection out of the thorax and into the thoraco-abdominal wall. 

Reticular and nodular densities are seen in the left lung. There is consolidation, fibrosis, and punctate calcification in the left lower lobe. Subcentimeter nodules, cavitary lesion, and fibrosis, are seen in the right upper lobe. Reticular and nodular densities are also seen in the right upper, middle and lower lobes. Overall lung findings are compatible with the known pulmonary tuberculosis.

There are multiple small and marginal-sized mediastinal and left axillary lymph nodes.

Incidentally a small splenic cyst is seen.

Case Discussion

This is a case of empyema necessitans, also known as empyema necessitatis, which is an empyema with outward extension into the neighboring chest wall and surrounding soft tissues. 

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