A 53 year old man was admitted with dyspnoea. A chest radiograph and CT scan suggested bilateral encapsulated pleural empyema (fig 1A and B). Pleural puncture produced a massive purulent discharge which grew Streptococcus pneumoniae, confirming the diagnosis. The CT scan also showed an enlarged diameter of the thoracic aorta near the diaphragm (4.25 cm; fig 1B). After starting treatment with antibiotics and pleural drainage with flushing, the patient …