Contained thoracic empyema presenting as an anterior chest wall abscess: empyema necessitatis revisited

Protean manifestation of pulmonary and pleural space infections can be expected in drug addicts. Because of the need to establish strict environmental protection for staff and patients, even simple drainage procedures should be performed in the operating room. Without testing, these patients should be considered as potential carriers of the AIDS virus. If a subcutaneous abscess is found to extend into the pleural space, drainage and full lung expansion are attempted through a limited rib resection. If this is unsuccessful, a full thoracotomy should be done to meet these surgical objectives.