Spontaneous Rupture of Empyema Necessitans in the Emergency Department

Abstract

An empyema necessitans is a rare complication of a collection of purulent material in the pleural space that spreads outside of the pleural cavity and involves the soft tissues of the chest wall. Due to compression forces created by the size of the collection of empyema in the chest cavity, patients are usually symptomatic and present with severe dyspnea. Chest X-ray or ultrasound of the chest cavity are the ideal screening tools to visualize the empyema and followed by computerized tomography scan of the chest to confirm the presence and extent of the pathology. In rare occasions, the empyema can rupture spontaneously, which may lead to critical situation requiring emergent intervention. We report the case of a 72-year-old male who presented to the emergency department with severe dyspnea and was diagnosed with empyema necesitans. During the initial management of the case, the empyema necessitans ruptured spontaneously and required emergent interventions to stabilize the patient.

Keywords: computerized tomography; empyema; empyema necessitans; rupture of empyema; thoracostomy tube.

Figure 1. Chest X-ray at the time of arrival.

Figure 2. CT scan of the chest cavity. The arrow indicates one of the air-fluid level in the empyema necessitans.

CT: computerized tomography

Figure 3. Chest X-ray following thoracostomy tube placement.