Current Thoracic Surgery

Chronic empyema thoracis represents the end stage of pleural infection when early drainage and antimicrobial therapy are inadequate or absent. Progression of untreated empyea resulted in lung entrapment and fibrothorax. In rare, long-standing untreated cases, this pleural peel may undergo extensive dystrophic calcification, forming a rigid shell around the lung and causing severe restriction, chronic chest pain, and functional disability [1,2]. Computed tomography is the imaging modality of choice for chronic empyema and fibrothorax. Typical findings include circumferential pleural thickening, dense pleural calcification, reduction in hemithoracic volume, and compression of the underlying lung [3]. Clinically, patients develop restrictive ventilatory impairment, dyspnea, and reduced quality of life due to mechanical limitation of lung expansion. Chronic chest pain further contributes to morbidity.

Once calcified fibrothorax is established, surgery becomes the definitive treatment. Open thoracotomy with pleural decortication remains the standard approach in heavily calcified disease, allowing complete removal of the fibrous rind and restoration of lung expansion [4,5]. This case highlights the natural history and classic imaging appearance of chronic calcified empyema with fibrothorax. It emphasizes the critical importance of early diagnosis and timely management of pleural infections to prevent progression to this rare but disabling late sequela. Informed written consent has been taken from the participant before enrollment. Anonymizing data maintained patient confidentiality.

Figure 1. PA chest X-ray showing a large, dense, left-sided calcified mass occupying the hemithorax with associated volume loss, consistent with pleural pathology.

Figure 2. Axial contrast-enhanced CT scan demonstrating longstanding untreated empyema thoracis with a markedly thickened and calcified pleural peel adherent to the left lung, causing fibrothorax.

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding
The authors received no financial support for the research and/or authorship of this article.

Authors’ contribution
ZS,MSN; design, review, editing and co-writing the paper equally.

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