title: Empyema necessitans caused by actinomycosis: A case report.
abstract: BACKGROUND
  Pulmonary actinomycosis is an uncommon clinical entity that the practicing thoracic surgeon rarely encounters. Empyema necessitans represents an even less common presentation of this pathology, and the often indolent disease course leads to early misdiagnosis in many cases. Familiarity with the varied presentations and possible operative strategies is essential to obtaining successful outcomes.
  
  
  METHODS
  A 56-year-old male presented with swelling and pain over the lateral chest wall. Initial imaging studies demonstrated a mass concerning for infection vs. neoplasia. Further studies were obtained to confirm the diagnosis, with rapid progression of the mass. Surgical exploration with aggressive debridement of the chest wall without thoracotomy was performed. Actinomyces was identified on final pathology, confirming the diagnosis of Actinomycosis empyema necessitans.
  
  
  CONCLUSIONS
  Traditional management strategies often involve pulmonary resection in addition to extended duration antimicrobial therapy. This report describes the uncommon clinical presentation and successful management of actinomycosis empyema necessitans with early limited operative intervention.
  
  
  CONCLUSIONS
  In the event of minimal pulmonary involvement and absence of lung abscess, as was seen in this case, a thoracotomy with pulmonary resection can be avoided, and antibiotic duration limited.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6400 Fannin St, Suite 2850, Houston, TX 77030, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Atay
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6400 Fannin St, Suite 2850, Houston, TX 77030, United States; Memorial Hermann Southeast, 11914 Astoria Blvd., Suite 260, Houston, TX 77089, United States. Electronic address: Farzaneh.Banki@uth.tmc.edu.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Banki
authors.affiliation: Memorial Hermann Southeast, 11914 Astoria Blvd., Suite 260, Houston, TX 77089, United States.
authors.forename: Craig
authors.initials: C
authors.lastname: Floyd
keywords: Actinomycosis; Case report; Chest wall; Empyema; Infection