RESUMEN
We present a case of a previously fit and well 28-year-old male who presented to the emergency department with respiratory distress and hypoxia four days after an alleged assault and blunt-force trauma to the chest wall. Initial clinical assessment and imaging suggested a likely diagnosis of delayed massive hemothorax associated with mediastinal shift. However, upon chest drain insertion, a large amount of pus was unexpectedly drained, leading to an immediate improvement in symptoms and restoration of mediastinal anatomy on repeat imaging. Our case illustrates that, although rare, empyemas can reach a significant volume before detection; they are capable of producing radiological and clinical intrathoracic tension configuration and can mimic hemothorax in the setting of trauma.