Abstract
Background
Empyema necessitans is a rare complication of pleural empyema characterized by the
dissection of pus through the soft tissues of the chest wall and eventually through
the skin. The skin manifestation may appear as a superficial abscess.
Case Report
A 63-year-old woman presented to the Emergency Department (ED) with a chief complaint
of dyspnea, dry cough, and a cutaneous nodule on her right chest wall. Three weeks
prior to her ED visit, she underwent an exploratory thoracotomy and chest tube placement.
The chest tube was removed 2 weeks later. Her physical examination was significant
for decreased breath sounds over her right lung fields and a painful, fluctuant, and
erythematous nodule on the right chest wall where the chest tube had previously been
inserted. Externally, the dermal findings appeared to be a superficial abscess. A
chest X-ray study showed a large pleural effusion in her right hemithorax. Point-of-care
ultrasound (POCUS) performed by an emergency physician showed evidence of a tract
extending from the nodule toward the pleural space that led to the correct diagnosis
and treatment of empyema necessitans.
Why Should an Emergency Physician Be Aware of This?
It is important to distinguish between a superficial abscess, which requires local
drainage, and empyema necessitans, which requires either chest tube drainage, open
drainage, or even decortication in specific cases. In such cases, POCUS can facilitate
a rapid, accurate diagnosis, and lead to the correct treatment.
Keywords
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Article info
Publication history
Published online: October 13, 2020
Accepted:
September 3,
2020
Received in revised form:
August 2,
2020
Received:
June 9,
2020
Footnotes
Streaming video: A brief real-time video clip that accompanies this article is available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clip 1.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
