Empiema necessitatis en un postoperatorio tardío: Reporte de caso de una complicación poco frecuente

Introduction. Empyema necessitatis is a rare complication that occurs in cases where empyema due to any etiology is not adequately and timely treated. It is defined as the extension of the empyema to the soft tissue of the chest wall, with involvement of the subcutaneous cellular tissue and occasionally the skin.Clinical case. The case of an 80-year-old male, who after four months of a thoracoscopy lobectomy developed constitutional symptoms and two abscesses on the the chest wall is presented. Empyema necessitatis was confirmed by computed tomography, which was treated with decortication by thoracotomy. Additionally, a squamous cell carcinoma of the lung was also diagnosed.Results. In this case, empyema necessitatis occurred in the late postoperative period after a thoracoscopy lobectomy, in a fragile patient with multiple comorbidities. The patient underwent surgical decortication, which is the ideal treatment in these cases, associated with the early initiation of antibiotics. Conclusions. The natural history of empyema must be known, a timely diagnosis and adequate treatment must be made to avoid complications, such as empyema necessitatis, which increases morbidity and mortality to patients. Timely initiation of antibiotics and pleural decortication, by thoracoscopy or thoracotomy, are the cornerstones of treatment.