Abstract
A 59-year-old man presented with high fever and tenderness extending from the left side of the chest to the flank. Computed tomography showed a large encapsulated pleural effusion in the left thoracic cavity with subfascial fluid extending from the left chest wall to the abdominal wall (Figure 1). He was diagnosed with empyema necessitatis. The patient developed septic shock and underwent urgent lavage and drainage of the abscess cavity. Because a large bronchopulmonary fistula was detected at the level of the segmental bronchus, temporary closure was considered difficult and fenestration was performed.
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