C45-04 Why Does That Empyema Have Hair in It?

Abstract Intro Mature cystic teratoma (MCT) is a germ cell tumor most notable for containing various types of tissue such as hair, skin, and teeth. These tumors are typically small, benign, and slow growing resulting in a predominately asymptomatic lifespan. In this case, we describe a rare instance of rapidly progressive empyema resulting from rupture of an anterior mediastinal MCT. Case Description A 32-year-old male with no significant past medical history presented to the emergency department with acute onset of severe, pleuritic chest pain and dyspnea. He described the pain as 10 out of 10 and unlike anything he had previously experienced. He denied cough, malaise, night sweats, weight loss, or recent travel. A chest x-ray was obtained that showed pleural effusion; A CT angiogram of the chest was then ordered as a follow-up diagnostic and demonstrated a large left anterior mediastinal mass measuring 8.9 × 7.7 × 11.5 cm. The mass was heterogeneous, containing soft-tissue, fat, and rim-like calcifications, and was in close proximity to the main pulmonary artery, abutting the left atrial appendage and left ventricle. A small left pleural effusion was also noted. Within 72 hours, the pleural effusion rapidly evolved into a complex, loculated empyema with extremely viscous fluid. Two bedside chest tube attempts were unsuccessful due to dense pleural inflammation and minimal drainage. The patient subsequently underwent surgical decortication and mass resection. Intraoperatively, the mass contained hair and sebaceous material, consistent with a mature cystic teratoma, which had partially ruptured into the pleural space, leading to secondary empyema. The left phrenic nerve was found to be involved, resulting in ipsilateral diaphragmatic paralysis. Conclusion Perforated MCT is a rare cause of empyema. The reported rate of rupture in mature cystic teratomas is approximately 1-2%, with subsequent empyema formation being even more uncommon. Empyema secondary to MCT can often mimic other infectious processes, potentially delaying definitive diagnosis and treatment. Clinicians should be aware of this rare complication to facilitate timely recognition and appropriate management. This abstract is funded by: none