Introduction
Empyema necessitans (EN), also known as empyema necessitates, is an infrequent pathological process that may arise when an empyema penetrates and breaches the pleural membrane, subsequently extending beyond the pleural space and following the path of least resistance through the adjacent soft tissues (1). It typically arises as a secondary complication of an underlying pneumonia or parapneumonic effusion, although it may also occur as a consequence of an infection at alternative sites (2). Other potential etiologies of EN comprise chest trauma or surgical procedures, albeit rare, as well as foreign body aspiration (3). EN may also occur in immunocompromised individuals, such as those receiving immunosuppressive therapy or with underlying HIV or cancer (4). Empyema necessitans may manifest with various clinical symptoms, including but not limited to local pain, cough, dyspnea, fever, and weight loss (5). The symptoms of Empyema necessitans can be managed with a range of treatment options, including the administration of antibiotics, tube drainage, and decortication, which can effectively eliminate the cavity and restore optimal pulmonary function (6). In this report, we present a case of pediatric Staphylococcus-associated Empyema necessitans, which was characterized by the presence of purulent drainage from the chest wall. The patient received treatment through open drainage by video-assisted thoracic surgery (VATS), a tube thoracotomy, and a course of antibiotics.