Empyema necessitatis for thoracic traumatism. A clinical diagnosis

Abstract

Empyema necessitatis is a rare long-term complication of thoracic empyema characterized by pus dissecting through soft tissue and skin of the chest wall. The pus communicates with the outside, forming a fistula between the pleural cavity and the chest wall skin. The most common etiological agent is Mycobacterium tuberculosis and Actynomices israelii. The inicial treatment for this kind of empyema includes broad spectrum antibiotics besides the surgical drainage. The case of a 47 year old male patient, was reported and presented diabetes and chronic alcoholism. He was injured on the right side hemithorax. There also the presence of a pleural burst blood vessel . A CT scanner showed the hemorrhage had invaded the chest wall. The culture for tuberculosis and the polymerase chain reaction test were negative. The cytology study was not malignant. Thoracotomy and fasciotomy surgeries were carried out to drain the empyema and the patient recovered from the empyema necessitatis.