Empyema Necessitans (EN) on Chest POCUS



Pulmonary teaching case: you are called to the bedside of a 60yo man who was admitted for pneumonia a week ago. You were called because “he coughed and now his chest is PULSATING!” This is what you see at the site of a previously removed chest drain on POCUS - What’s the diagnosis?



This is Empyema necessitans (EN): EN is a rare complication of an infected pleural effusion where purulent fluid “escapes” the pleura and erodes into the chest wall, causing an extrapleural fluid collection that communicates with the pleural space.



Because Empyema necessitans communicates with the pleural space, fluid can move back & forth with respiration, as seen here.  With inspiration, negative intra-thoracic pressure pulls the fluid into the chest. With expiration, positive intra-thoracic pressure pushes fluid out.



Nick Mark MD @nickmmark



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