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Hepatic abscesses can rupture and spread the infection to the thoracic cavity, resulting in the formation of a hepato-thoracic fistula, rarely. We report an autopsy case of a middle-aged female who died suddenly following nonspecific systemic symptoms. Postmortem examination revealed a large ALA that had ruptured through the diaphragm, leading to massive pleural empyema. This autopsy case report underscores the importance of early clinical suspicion, imaging, and surgical management to prevent such catastrophic outcomes.<\/jats:p>","DOI":"10.1177\/00258024261439476","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:47:51Z","timestamp":1777466871000},"page":"442-446","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The lung pays the price: Massive pleural empyema as a rare complication of amoebic liver abscess \u2013 an autopsy case report"],"prefix":"10.1177","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4646-8705","authenticated-orcid":false,"given":"Munesh","family":"Kumar","sequence":"first","affiliation":[{"name":"Vardhman Mahavir Medical College and Safdarjung Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7532-0055","authenticated-orcid":false,"given":"Vijay","family":"Sharma","sequence":"additional","affiliation":[{"name":"Vardhman Mahavir Medical College and Safdarjung Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1886-3567","authenticated-orcid":false,"given":"Deep","family":"Roy","sequence":"additional","affiliation":[{"name":"Vardhman Mahavir Medical College and Safdarjung Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Vardhman Mahavir Medical College and Safdarjung Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.K.","family":"Tandon","sequence":"additional","affiliation":[{"name":"Vardhman Mahavir Medical College and Safdarjung Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.meegid.2009.06.008"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12830-9"},{"key":"e_1_3_2_4_2","first-page":"819","article-title":"Parasite related diarrhoeas. 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