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.