Salas Thaj¹, Kashish Jain H², Nagarjuna D³*, Upendra N³ and RS Meghasri³

¹Pharm D Intern, Department of Pharmacy Practice, TVM College of Pharmacy, Ballari, Akshaya Institute of Pharmacy, Tumkur, Karnataka, India
²V Pharm D Student, Department of Pharmacy Practice, TVM College of Pharmacy, Ballari, Akshaya Institute of Pharmacy, Tumkur, Karnataka, India
³Assistant Professor, Department of Pharmacy Practice, TVM College of Pharmacy, Ballari, Akshaya Institute of Pharmacy, Tumkur, Karnataka, India

*Corresponding Author: Nagarjuna D, Assistant Professor, Department of Pharmacy Practice, TVM College of Pharmacy, Ballari, Akshaya Institute of Pharmacy, Tumkur, Karnataka, India.

Received: August 25, 2025; Published: September 10, 2025

Abstract

Empyema Necessitans (EN) is a rare complication of a pleural effusion. Empyema is characterized by the presence of pus in the pleural space, typically resulting from a complicated chest infection (TB) or pneumonia. Pneumonia can lead to severe complications, including para-pneumonic effusions, empyema, and potentially life-threatening sepsis, especially in individuals with underlying conditions that weaken the immune system. A 45-year-old male patient presented to the General Medicine department with persistent, progressive right lateral thoracic swelling for the last 2 months which was associated with mild pain on palpation. He complained chest pain on breathing, fever with chills, and a weight loss of around 6kg over the last 2 months. He denied symptoms of haemoptysis, shortness of breath, orthopnoea or recent travel. However, he did report a weight loss of approximately 6 kg in the last 2 months, with a BMI of 17.7. He had a past medical history of pneumonia a few months ago, and a cough with expectoration for 1 month. He also had a history of hypertension. He was a labourer at a construction site and had a history of smoking for 7 years. Values of ESR and CRP and WBC were found elevated. The patient was hospitalized for 7 days with Antibiotic course, Analgesic & PPIs. A chest X-ray was carried out, revealing pleural effusion in the right lung. Consequently, a Chest CT scan was also ordered, which showed a fluid-density collection in the right hemithorax along the lateral chest wall, measuring about 5.0 cm in its maximum thickness, with passively collapsed underlying parenchyma. Based on the findings from the CT scan, the patient was admitted for surgical intervention. Subsequently, under sedation, thoracentesis was performed, and a sample was sent for testing which revealed yellowish purulent discharge coming from the thoracic cavity through the intercoastal space revealing a connection between fluid collection outside the thoracic wall and the pleural cavity and showed positive for streptococcus pneumoniae. The entire content was then drained by ICD tube insertion thus diagnosing Empyema Necessitans (EN).

Keywords: Empyema Necessitans; Para Pneumonic Effusion; Pleural Cavity; Thoracentesis; Thoracostomy

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Citation

Citation: Nagarjuna D., et al. “A Case Study on Empyema Necessitans". Acta Scientific Pharmaceutical Sciences 9.10 (2025): 03-11.

Copyright

Copyright: © 2025 Nagarjuna D., et al. 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.