Since the advent of antibiotic treatment empyema has become an uncommon disease, and thus empyema necessitates has become extremely rare.1 A 68-year-old woman was admitted to hospital with a mass protruding from the left chest wall (fig 1A). Chest x-ray findings showed calcified pleural plagues on the left paracardiac area. Computed tomography disclosed an abscess with highly calcified pleural thickening and extension from the pleura through the chest wall and skin (fig 1B). To reduce the patient’s symptoms a large-bore chest catheter was inserted into the abscess under sedation. When the drainage from the tubes reduced she eventually underwent open thoracostomy with two costal resection. Biopsy specimens that were taken from both pleura and the abscess cavity were free from mycobacterium. Meticulous stoma dressings were done in the follow-up period. We illustrate a rare case with highly interesting inspection and radiological features.

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Figure 1 (A) A mass on the left lower chest wall; (B) chest radiograph shows calcified pleural thickening on the left lower zone; (C, D) computed tomography depicts a localised pleural abscess with calcified thick wall and necessitation of pus through the skin.