<s>[INST] Doctor, I recently observed a small open area in a family member s chest. I was told opening has been present since early childhood, (25 years of age now). Family member shared there has occasionally been drainage from the area, (foul order). What is possible cause of opening/drainage? [/INST] Thanks for your question on Chat Doctor. You should immediately consult pulmonologist for your family member because possibility of emphysema necessities is high in this case. Emphysema necessities is chronic bacterial infection of pleura which is spreading to the overlying skin and cause discharging sinus. Your family member is also having discharge with foul smell, this suggests possibility of mixed (aerobic and anaerobic) infection more. Treatment of emphysema necessities is video assisted thoracoscopic surgery (VATS). In this infected pleura and pus is removed and sinus has been closed. Patient needs antibiotics for 1-2 months. So better to consult pulmonologist and discuss all these. </s>