Risk factors:
(1) inadequate treatment of an empyema or lung abscess
(2) necrotizing infection
Complications:
(1) cellulites or soft tissue abscesses in the chest wall
(2) osteomyelitis of ribs and/or scapula
(3) cutaneous fistula
(4) subcutaneous emphysema
Organisms associated with empyema necessitans may include:
(1) actinomycosis
(2) Staphylococcus aureus
(3) Fusobacterium nucleatum
(4) Streptococcus milleri
(5) Mycobacterium tuberculosis
(6) Streptococcus pyogenes
(7) polymicrobic infection
It is important to culture the material for recovery of slow growing bacteria, anaerobic bacteria, fungi and acid fast bacilli.
