Case presentation

A 59-year-old man with a history of encephalopathy in bedridden state since childhood presented to our hospital with a left-sided enlarging chest wall mass of a 2-month duration. On physical examination, his vital signs were as follows: temperature, 35.8°C; pulse rate, 54/min; respiratory rate, 28/min; and blood pressure, 79/39 mm Hg. He displayed a tender, erythematous, fluctuant mass (9×8 cm) over the left anterior chest (figure 1A) and tenderness in the left upper quadrant. Moreover, poor dentition was noted. The laboratory studies showed leucocytosis (17.5×10⁹/L) with predominant neutrophil count (88%) and elevated C-reactive protein level (164.8 mg/L). Chest radiography revealed an opacification extending from left lower lung field to left subphrenic region and blurred left costophrenic angle (figure 1B). Ultrasonography of the chest wall mass presented fluid collections with the communication between the chest wall and the pleural cavity …