Empyema

Empyema - pleural; Pyothorax; Pleurisy - purulent

Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space).

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Causes

Empyema is usually caused by an infection that spreads directly from the lung. It leads to a buildup of pus in the pleural space.

There can be 2 cups (1/2 liter) or more of infected fluid. This fluid puts pressure on the lungs.

Risk factors include:

Bacterial pneumonia
Bacterial pneumonia
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers community-acquired pneumonia (CAP). ...
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Tuberculosis
Tuberculosis
Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.
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Chest surgery
Lung abscess
Lung abscess
An abscess is a collection of pus in any part of the body. In most cases, the area around an abscess is swollen and inflamed.
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Trauma or injury to the chest

In rare cases, empyema can occur after thoracentesis. This is a procedure in which a needle is inserted through the chest wall to remove fluid in the pleural space for medical diagnosis or treatment.

Symptoms

Symptoms of empyema may include any of the following:

Chest pain, which worsens when you breathe in deeply (pleurisy)
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
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Dry cough
Cough
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...
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Excessive sweating, especially night sweats
Excessive sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
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Fever and chills
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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General discomfort, uneasiness, or ill feeling (malaise)
Malaise
Malaise is a general feeling of discomfort, illness, or lack of well-being.

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Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
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Weight loss (unintentional)
Weight loss
Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...

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Exams and Tests

The health care provider may note decreased breath sounds or an abnormal sound (friction rub) when listening to the chest with a stethoscope (auscultation).

Tests that may be ordered include:

Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
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CT scan of chest
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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Thoracentesis
Thoracentesis
Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest....

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Pleural fluid analysis
Pleural fluid analysis
Pleural fluid analysis is a test that examines a sample of fluid that has collected in the pleural space. This is the space between the lining of th...

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Treatment

The goal of treatment is to cure the infection. This involves the following:

Placing a tube in your chest to drain the pus
Giving you antibiotics to control the infection

If you have problems breathing, you may need surgery to help your lung expand properly.

Outlook (Prognosis)

When empyema complicates pneumonia, the risk for permanent lung damage and death goes up. Long-term treatment with antibiotics and drainage are needed.

In general, most people fully recover from empyema.

Possible Complications

Having empyema may lead to the following:

Pleural thickening
Reduced lung function

When to Contact a Medical Professional

Contact your provider if you develop symptoms of empyema.

Prevention

Prompt and effective treatment of lung infections may prevent some cases of empyema.

Open References

References

Broaddus VC, Light RW. Pleural effusion. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 108.

McCool FD. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 92.

Lungs - illustration
The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Lungs
illustration
Chest tube insertion - series - Pleural cavity
Presentation

<strong>Chest tube insertion - series - Pleural cavity</strong><p>The pleural cavity is the space between the layers of the membrane lining the lung (pleura) and the chest cavity. </p>

<strong>Hemothorax</strong><p>If fluid, such as blood, or air, gets into the pleural space, the lung can collapse, preventing adequate air exchange. Chest tubes are used to treat conditions that can cause the lung to collapse, such as air leaks from the lung into the chest (pneumothorax), bleeding into the chest (hemothorax), after surgery or trauma in the chest (pneumothorax or hemothorax), lung abscesses or pus in the chest (empyema). </p>

<strong>Chest tube insertion</strong><p>Chest tubes are inserted to drain blood, fluid, or air and allow full expansion of the lungs. The tube is placed in the pleural space. The area where the tube will be inserted is numbed (local anesthesia). The patient may also be sedated. The chest tube is inserted between the ribs into the chest and is connected to a bottle or canister that contains sterile water. Suction is attached to the system to encourage drainage. A stitch (suture) and adhesive tape is used to keep the tube in place. The chest tube usually remains in place until the X-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded. When the chest tube is no longer needed, it can be easily removed, usually without the need for medications to sedate or numb the patient. Medications may be used to prevent or treat infection (antibiotics).</p>

<strong>Before and after chest tube insertion</strong><p>Recovery from the chest tube insertion and removal is usually complete, with only a small scar. The patient will stay in the hospital until the chest tube is removed. While the chest tube is in place, the nursing staff will carefully check for possible air leaks, breathing difficulties, and need for additional oxygen. Frequent deep breathing and coughing is necessary to help re-expand the lung, assist with drainage, and prevent normal fluids from collecting in the lungs.</p>

Lungs - illustration
The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.
Lungs
illustration
Chest tube insertion - series - Pleural cavity
Presentation

Tests for Empyema

Review Date: 9/1/2021

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Empyema

Causes

Bacterial pneumonia

Tuberculosis

Lung abscess

Thoracentesis

Symptoms

Chest pain

Cough

Excessive sweating

Fever

Malaise

Shortness of breath

Weight loss

Exams and Tests

Auscultation

Chest x-ray

CT scan

Thoracentesis

Pleural fluid analysis

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Prevention

References

Lungs - illustration

Lungs

Chest tube insertion - series - Pleural cavity

Lungs - illustration

Lungs

Chest tube insertion - series - Pleural cavity

Tests for Empyema

Health Library

Empyema

Causes

Bacterial pneumonia

Tuberculosis

Lung abscess

Thoracentesis

Symptoms

Chest pain

Cough

Excessive sweating

Fever

Malaise

Shortness of breath

Weight loss

Exams and Tests

Auscultation

Chest x-ray

CT scan

Thoracentesis

Pleural fluid analysis

Treatment

Outlook (Prognosis)

Possible Complications

When to Contact a Medical Professional

Prevention

References

Lungs - illustration

Lungs

Chest tube insertion - series - Pleural cavity

Lungs - illustration

Lungs

Chest tube insertion - series - Pleural cavity

Tests for Empyema

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