Background: Empyema necessitans is an atypical long–term complication of empyema distinguished by the leakage of pus from the pleural space into the proximate chest wall and soft tissues setting up a connection between the pleural infection, and the subcutaneous tissue. We review a case of a 25 year old female presenting with  increasing mass on the left side of her back since 1 month. A swelling is noted  in the right paraspinal region in the intramuscular plane. Radiological  procedures including USG, NECT showed empyema necessitans.

Conclusion: Empyema necessitans is mainly caused by Mycobacterium tuberculosis and Actinomyces israelii.