The authors describe a man presenting with 2 weeks of dyspnea and a rapidly enlarging tender mass on his left back. Anyone looking at the picture of the patient’s back will know that something foul is at play. Indeed, cross-sectional imaging showed a complicated pleural effusion containing gas that appeared to have forced its way out of the chest cavity into the thoracic wall, making the diagnosis of empyema necessitans (EN): the term “necessitans” comes from the Latin necessitare, meaning “to render necessary.” In addition to learning some Latin, clinicians should know that EN is rare and is generally caused by indolent pathogens like Mycobacterium tuberculosis. However, Streptococcus intermedius was the rotten egg in this case.
Comment
The authors describe a man presenting with 2 weeks of dyspnea and a rapidly enlarging tender mass on his left back. Anyone looking at the picture of the patient’s back will know that something foul is at play. Indeed, cross-sectional imaging showed a complicated pleural effusion containing gas that appeared to have forced its way out of the chest cavity into the thoracic wall, making the diagnosis of empyema necessitans (EN): the term “necessitans” comes from the Latin necessitare, meaning “to render necessary.” In addition to learning some Latin, clinicians should know that EN is rare and is generally caused by indolent pathogens like Mycobacterium tuberculosis. However, Streptococcus intermedius was the rotten egg in this case.