Empyema

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

Causes of Empyema

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

There can be a pint or more of infected fluid. This fluid puts pressure on the lungs.

Risk factors include:

• Bacterial pneumonia
• Chest surgery
• Lung abscess
• Trauma or injury to the chest

In rare cases, empyema can occur after a needle is inserted through the chest wall to draw off fluid in the pleural space for medical diagnosis or treatment (thoracentesis).

Empyema Symptoms

• Chest pain, which worsens when you breathe in deeply (pleurisy)
• Dry cough
• Excessive sweating, especially night sweats
• Fever and chills
• General discomfort, uneasiness, or ill feeling (malaise)
• Shortness of breath
• Weight loss (unintentional)

Tests and Exams

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 may include the following:

• Chest x-ray
• CT scan of chest
• Pleural fluid Gram stain and culture
• Thoracentesis

Treatment of Empyema

The goal of treatment is to cure the infection and remove the collection of pus from the space between the lung and the inner surface of the chest wall. Antibiotics are prescribed to control the infection.

The health care provider will place a chest tube to completely drain the pus. A surgeon may need to perform a procedure to peel away the lining of the lung (decortication) if the lung does not expand properly.

Prognosis (Outlook)

When empyema complicates pneumonia, the risk of permanent lung damage and death goes up. Patients will need long-term treatment with antibiotics and drainage. However, most people fully recover from empyema.

Potential Complications

• Pleural thickening
• Reduced lung function

When to Contact a Health Professional

Call your health care provider if you develop symptoms of empyema.

Prevention of Empyema

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

Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.

Broaddus VC, Light RW. Pleural effusion. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 68.

Lungs	Respiratory system	Chest tube insertion - series

Review Date: 3/11/2011
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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