Empyema Necessitatis

A 40-year-old man presented with a 3-month history of fever, weight loss, dyspnea, and cough. Physical examination revealed a tender, bulging anterior thoracic mass and a small ulcerative lesion that was inferomedial to the right nipple (Panel A). Computed tomographic scans showed a pleural effusion (Panel B) that extended through the chest wall (Panel C, arrow), along with accompanying bone destruction. Surgical exploration revealed purulent pleural fluid; a culture of the fluid grew Mycobacterium tuberculosis. Empyema necessitatis is a complication of pleural empyema that is characterized by extension of purulent fluid through the parietal pleura into the chest wall. A chest tube was placed for 3 weeks; the patient was treated for 9 months with rifampin, isoniazid, pyrazinamide, and ethambutol, and he recovered fully.

一名40岁男性患者主诉发热、体重减轻、呼吸困难及咳嗽3个月。体格检查发现前胸壁有一压痛突出肿物，右侧乳头内下方有一小的溃疡性病变（图A）。CT扫描显示胸腔积液（图B）穿透胸壁（图C，箭头），并伴有骨骼破坏。手术探查发现脓性胸腔积液；胸腔积液培养分离到结核分枝杆菌。自发性脓胸是胸腔积脓的一种并发症，特点为脓性胸腔积液穿透壁层胸膜进入胸壁。留置胸管3个月；患者接受利福平、异烟肼、吡嗪酰胺及乙胺丁醇，疗程9个月，患者完全康复。