Presentation
Fever, shortness of breast and chest pain.
Patient Data
A large right pleural fluid collection with internal gas foci is noted which has an extension into the right chest wall between the right tenth and eleventh ribs. The overlying skin is intact. No bony erosion is seen.
A small nodule is noted in the right middle lobe along the horizontal fissure which is most likely lymph node.
The left lung is normal.
Case Discussion
CT findings and clinical presentation are in keeping with empyema necessitans.
The presence of gas favours a bacterial cause however no organism has been isolated at the time of publication.
Co-contributor: Dr Anwar-ul-Haq Zadran