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Into the Abscess: A 50 Year-Old Man with Empyema Necessitans | OMICS International
ISSN: 2161-105X
Journal of Pulmonary & Respiratory Medicine

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Into the Abscess: A 50 Year-Old Man with Empyema Necessitans

Avraham Zvi Cooper*, Jennifer Sawaya and Jared Grochowsky

Avraham Zvi Cooper, Medical Resident, Beth Israel Deaconess Medical Center,, Internal medicine, USA

*Corresponding Author:
Avraham Zvi Cooper
Medical resident
Beth Israel Deaconess Medical Center
Internal Medicine
330 Brookline Ave
Boston, MA 02215, USA
Tel: 6178178406
E-mail: [email protected]

Received date: March 29, 2015; Accepted date: April 15, 2015; Published date: April 20, 2015

Citation: Cooper AZ, Sawaya J, Grochowsky J (2015) Into the Abscess: A 50 Year-Old Man with Empyema Necessitans. J Pulm Respir Med 5:i017. doi:10.4172/2161-105X.1000i017

Copyright: © 2015 Cooper AZ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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A 50-year-old man presented with two months of malaise, weight loss, and back pain after an accidental aspiration. Labs showed a neutrophilic leukocytosis of 23,000/uL. Imaging revealed a large pleural and paraspinal fluid collection (Figures 1-3), extending down to the pelvis, consistent with empyema necessitans and paraspinal


Figure 1: Coronal chest CT views showing a complicated right-sided basilar pleural and paraspinal fluid collection (red arrows) consistent with empyema necessitans.


Figure 2: The collection extends from the chest wall to the pelvis.


Figure 3: Extension of the fluid collection (red arrow) into the thoracic and lumbar paraspinal soft tissues (green arrow) as seen on sagittal chest CT.

abscess. Cultures grew Streptococcus anginosus (also known as Strep. milleri). He received antibiotics and drainage, with course complicated by malnutrition, tracheostomy, and encephalopathy. His care was eventually transitioned to comfort-focused. Commonly causing brain and abdominal abscesses, S. anginosus uncommonly causes empyema, usually from aspiration [1]. It produces hyaluronidase, allowing for liquefaction of and extensive spread through tissues [2].


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