This is a large plaque of fibrous tissue which has been removed on the outer side from the ribcage and the rib markings can be seen on the reverse of the specimen. The inner surface has been peeled from the lung. One irregular cavity can be seen at one margin and a cyst-like protrusion is apparent on the lower part of the specimen. The fibrous tissue appears to be up to 2 cm thick in some areas.
This patient presented at the age of 11 years with a 4 day history of fever, malaise, cough and breathlessness. Examination showed a left basal pneumonia with a large left pleural effusion. After 14 days treatment he was much improved but still breathless on exertion and had a low intermittent fever. An empyema developed, there was no growth on culture at 4 weeks. Examination at this stage showed marked approximation of the ribs on the left, very poor movement of the left chest, a fixed raised left diaphragm and a scoliosis with the concavity to the left. The sac was removed.