Interesting ImagePET Appearance of Tuberculous Empyema NecessitansLungren, Matthew P. MD; Christensen, Jared D. MD; Coleman, R. Edward MD; Gupta, Rajan T. MDAuthor Information From the Duke University Medical Center, Department of Radiology, Durham, NC. Received for publication December 14, 2010; revision accepted April 1, 2011. Conflicts of interest and sources of funding: R.E.C. is a member of the Medical Advisory Board for General Electric Healthcare. R.E.C. has received a grant from General Electric Healthcare. All other authors have no conflicts of interest. Reprints: Rajan T. Gupta, MD, Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710. E-mail: [email protected]. Clinical Nuclear Medicine: October 2011 - Volume 36 - Issue 10 - p 939-941 doi: 10.1097/RLU.0b013e3182291bfd Buy Metrics Abstract A 28-year-old man with no medical history presented with right-sided swelling of the chest. Findings from the CT scan revealed multiple subcutaneous cystic masses and cavitary lung lesions. FDG PET imaging demonstrated hypermetabolic cavitary lung lesions and cyst walls with no central uptake. Polymerase chain reaction fluid analysis confirmed the growth of Mycobacterium tuberculosis. Operative incision and drainage yielded 2.5 L of purulent material. First described in the 17th century, the hallmark presentation of empyema necessitans is anterior chest wall soft-tissue swelling. M. tuberculosis remains its most common cause. Extraparenchymal collections begin with tuberculosis pleuritis followed by caseous material eroding through the chest wall into fascial planes. Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.