Asymptomatic man with an incidental finding of a massive empyema

BMJ Case Rep. 2020 Sep 10;13(9):e237178. doi: 10.1136/bcr-2020-237178.


We describe the case of a 67-year-old asymptomatic man who was referred to our hospital for abnormal laboratory results. He was incidentally found to have a massive empyema without underlying bronchopulmonary pneumonia. Following thoracentesis, he was diagnosed with chronic Streptococcus anginosus empyema. Therapeutic thoracentesis and treatment with tissue plasminogen activator and deoxyribonuclease failed to resolve the empyema, and there was residual loculated pleural fluid that was surrounded by a thick rind. The patient was referred to thoracic surgery for decortication of the pleural space via video-assisted thoracoscopic surgery. At 2-month follow-up, the patient had complete re-expansion of the lung tissue.

Keywords: cardiothoracic surgery; empyema; medical management.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Deoxyribonucleases / therapeutic use
  • Empyema, Pleural / diagnosis*
  • Empyema, Pleural / drug therapy*
  • Empyema, Pleural / microbiology
  • Empyema, Pleural / surgery*
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Incidental Findings
  • Male
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / surgery
  • Streptococcus anginosus / isolation & purification
  • Thoracentesis
  • Thoracic Surgery, Video-Assisted / methods
  • Tissue Plasminogen Activator / therapeutic use


  • Fibrinolytic Agents
  • Deoxyribonucleases
  • Tissue Plasminogen Activator