Missed foreign body and nessitans empyema.

Area of Science:

• Pulmonology
• Infectious Diseases
• Thoracic Surgery

Background:

• Recurrent empyema poses a diagnostic and therapeutic challenge.
• Empyema necessitans is a rare but severe manifestation of thoracic infection.
• Foreign body aspiration into the airway can lead to complex thoracic complications.

Observation:

• A case of recurrent empyema over three months is presented.
• The empyema progressed to an empyema necessitans, involving skin protrusion.
• The causative agent identified was Fusobacterium varium.

Findings:

• The empyema recurrence stemmed from an aspirated animal vertebra.
• The foreign body lodged in the right main bronchus.
• The presentation mimicked an endobronchial tumor, complicating diagnosis.

Implications:

• Highlights the importance of considering unusual foreign bodies in recurrent thoracic infections.
• Underscores the need for advanced imaging and bronchoscopy in diagnosing endobronchial lesions.
• Emphasizes the potential for severe complications from seemingly minor airway injuries.