대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary tuberculosis with empyema necessitatis

Radiologic Findings

Brief Review

Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal pleura, usually into the chest wall, to form a subcutaneous abscess that eventually may rupture through the skin. It may extend following anatomical boundaries. Tuberculous empyema is most commonly a result of rupture of a subpleural caseous focus into the pleural space. Rarely, it is secondary to hematogenous spread extension from involved thoracic lymph nodes or from a subdiaphragmatic focus. Tuberculosis(73%) is more likely to form an empyema necessitans than are pyogenic organisms. Overall mortality was revealed 66% and involvement of the psoas and lumbar regions was nearly 100% fatal in Sindel's study.
In case of chest wall involvement, radiographs shows soft tissue mass in the chest wall with or without bony destruction and CT shows a thick-walled well preserved encapsulated soft tissue mass with central low attenuation and peripheral rim enhancement. Osteolytic expansile lesions with cortical disruption and cortical irregularities are can be seen. Costal cartilage and sternoclaviculr joint can be also affected. Direct communication between the pleura and chest wall lesion is rarely seen.

References

1. Peterson MW, Austin M, Yip CK et al. CT findings in transdiaphragmatic empyema necessitatis due to tuberculosis. JCAT 1987:11;704-706
2. Jung-Hyun Chang, Sung Kyu Kim, Se Kyu Kim et al. Tuberculosis of the rib: A recurrent attack of rib caries. Yonsei Medical Journal 1992:33;374-378
3. Alfageme I, Munoz F, Pena N, Umbra S. Empyema of the thorax in adults. Chest 1993:103;839-843

Keywords

Lung, Chest wall, Infection, Bacterial infection, tuberculosis,