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Fig. 6A. —Empyema necessitatis in 23-year-old man. CT scans reveal thick-walled, bilobed fluid collection involving both pleural cavity (A) and adjacent chest wall (B) without adjacent rib destruction. Direct communication between pleural (arrows, A) and chest wall fluid collection (arrows, B) is not shown on this CT scan. Patient had history of tuberculous pleuritis 5 years ago and presented with chest pain of 1-2 months' duration. He underwent surgery and no rib destruction was found, consistent with findings on CT.