Empyema necessitansis a condition where the empyema has diffused and is loculated in the extra pleural space. Empyema necessitans is a very rare and morbid condition requiring urgent intervention to promote optimal outcomes. It is usually caused by Tuberculosis (TB) infection or immunocompromised condition. Its manifestation, which is often vague in the beginning, leads to diagnostic dilemmas and delays in management. We describe a rare case of empyema necessitans in a 51 years-old male who presented with leftside chest wall swelling. Ultrasonography of the anterior chest wall revealed a left anterior chest wall collection with intrathoracic extension. HRCT shows segmental collapse with cavitary changes with atelectatic bands in left upper lobe and left costo-pleural thickening with minimal left pleural effusion with hypodenseloculated collection of 36cc in left anterior chest wall region Percutaneous drainage of the collection was performed, and the pus sent for Mycobacterium tuberculosis culture was negative.