Empyema necessitatis is a rare complication of empyema characterized by extension of suppuration from the pleural space through the chest wall. The most common etiologies are tuberculosis and actinomycosis. We describe a 1-year-old boy with Streptococcus pneumoniae empyema necessitatis and review previously reported cases.
Baillou 1 first described empyema necessitatis or necessitans in 1640 in a woman who had a left-sided pulsating tumor associated with pleurisy. In his famous text on auscultation in 1819, Laennec 2 reported a 12-year-old boy who developed empyema necessitatis at age 6 years that led to a chronic draining fistula in the left sixth-seventh interspace anteriorly. Sindel 3 published the last comprehensive literature review of empyema necessitatis in 1940, summarizing 112 worldwide cases. Since that time empyema necessitatis has been a very uncommon complication of empyema characterized by extension of suppuration from the pleural space, typically through the thoracic wall, to form a subcutaneous abscess. Less commonly the extension is through the bronchus, esophagus, diaphragm, breast, pericardium or mediastinum. This complication occurs most frequently after a chronic empyema related to an indolent infection such as tuberculosis or actinomycosis. Pediatric cases and pneumococcal etiology are exceedingly rare.
We describe a 1-year-old boy who presented with Streptococcus pneumoniae empyema necessitatis, and we provide a literature review including English language cases from 1966 to the present using the search words “empyema necessitatis” and “empyema necessitans.” Cases associated with previous thoracic surgery were excluded.