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A 28-year-old man with no medical history presented with right-sided swelling of the chest. Findings from the CT scan revealed multiple subcutaneous cystic masses and cavitary lung lesions. FDG PET imaging demonstrated hypermetabolic cavitary lung lesions and cyst walls with no central uptake. Polymerase chain reaction fluid analysis confirmed the growth of Mycobacterium tuberculosis. Operative incision and drainage yielded 2.5 L of purulent material. First described in the 17th century, the hallmark presentation of empyema necessitans is anterior chest wall soft-tissue swelling. M. tuberculosis remains its most common cause. Extraparenchymal collections begin with tuberculosis pleuritis followed by caseous material eroding through the chest wall into fascial planes.

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