CTICasesLung Abscess (MSSA) with Empyema Necessitans and Brachial Plexopathy
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Imaging findings
CT revealed a necrotic mass in the left upper chest, extending into the subcutaneous tissues with gas, consistent with a lung abscess and empyema necessitans. A small pleural effusion was also present. MR imaging of the brachial plexus showed the abscess/mass tracking into the region of the brachial plexus, with abnormal signal and enhancement around the nerve roots. Axial fat-suppressed sequences further highlighted abnormal signal within the chest wall extending superiorly into the brachial plexus region.
Key takeaways
A lung abscess can extend through the chest wall, forming an empyema necessitans, and subsequently involve adjacent structures like the brachial plexus, leading to neurological symptoms such as brachial plexopathy. Diagnosis was confirmed by sampling, growing methicillin-sensitive *Staphylococcus aureus* (MSSA). Treatment with antibiotics resulted in significant improvement in both pain and nerve symptoms, though full resolution of neurological deficits may take time. This represents a severe but treatable complication of lung infection.
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