The surface of the heart is shaggy in appearance; there is a thick pleural exudate apparent over the
left lower lobe with a patch of similar material at the apex of the upper lobe. The upper lobe shows
an almost confluent bronchopneumonia and there are patchy areas of consolidation in the lower
This woman presented at the age of 46 with a history of chest pain, shortness of breath
and being generally unwell for 10 days. She died shortly after admission into hospital. At autopsy,
100 millilitres of purulent fluid was found in the pericardial sac and she had a left-sided empyema.