Empyema
Empyema - pleural; Pyothorax; Pleurisy - purulentEmpyema 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
- Tuberculosis
- Chest surgery
- Lung abscess
- 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.
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Symptoms
Symptoms of empyema may include any of the following:
- 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)
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Exams and Tests
Your health care provider may note decreased breath sounds or an abnormal sound (friction rub) when listening to your chest with a stethoscope (auscultation).
Tests that may be ordered include:
- Chest x-ray (may require multiple positions)
- CT scan of chest
- Thoracentesis
- Pleural fluid analysis
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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.
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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.
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Possible Complications
Having empyema may lead to the following:
- Pleural thickening
- Reduced lung function
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When to Contact a Medical Professional
Contact your provider if you develop symptoms of empyema.
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Prevention
Prompt and effective treatment of lung infections may prevent some cases of empyema.
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, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 86.