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.
Departments of Pediatrics (AFF, STS) and Medical Imaging (TBA)
The Feinberg School of Medicine
Children’s Memorial Hospital
Accepted for publication Nov. 7, 2003.
Reprints not available.