The condition empyema occurs when pus accumulates in the pleural space between the lungs and the chest wall. In addition to chest pain, fever, cough, and breathing difficulties, empyema is usually a complication of pneumonia, but can also be caused by chest trauma, surgery, or other infections. If left untreated, empyema can lead to sepsis, lung collapse, or chronic lung damage. Empyema is therefore important to recognize and seek medical attention as soon as possible.
The most common bacteria that cause empyema are Streptococcus pneumoniae and Staphylococcus aureus, which also cause pneumonia. Empyema is caused by a bacterial infection that spreads from the lungs to the pleura. In addition to tuberculosis and lung abscesses, empyema can be caused by other bacteria.
The infection causes inflammation and fluid buildup in the pleural space, which normally contains only a small amount of lubricating fluid. The fluid becomes thick and cloudy with pus, which is a mixture of bacteria, white blood cells, and dead tissue. Pupum can compress the lungs, which makes breathing difficult. Additionally, it can damage the pleura, which line the lungs and chest wall.
The symptoms of empyema are similar to those of pneumonia, but they tend to be more severe and persistent. The symptoms may include:
Chest pain or discomfort, especially when breathing or coughing
Fever and chills
Cough, which may produce yellow or green sputum
Shortness of breath or difficulty breathing
Fatigue and weakness
Loss of appetite and weight loss
Night sweats
Headache and confusion
Some people may also experience hiccups, which are caused by irritation of the diaphragm and the phrenic nerve by the pus.
A doctor will perform a physical examination, ask about symptoms and medical history, and diagnose empyema. In addition to listening to the lungs with a stethoscope, the doctor will look for signs of infection, including fever, rapid breathing, and low blood pressure. Several tests may also be ordered by the doctor to confirm the diagnosis and determine the cause of the infection, including:
Chest X-ray or CT scan, which can show the presence and extent of fluid in the pleural space
Blood tests, which can check for signs of infection and inflammation, such as elevated white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)
As part of pleural fluid analysis, a needle is inserted into the pleural space and a sample of fluid is taken. Fluid can be examined for appearance, color, consistency, and pH. It can also be cultured to identify the type and sensitivity of the bacteria causing the infection.
With thoracoscopy, a thin, flexible tube equipped with a camera and light source (called a thoracoscope) is used to examine the inside of the pleural space. The doctor can also drain fluid or take tissue samples (biopsies).
The treatment of empyema aims to eliminate the infection and drain the pus from the pleural space. The treatment may include:
The choice and duration of antibiotics will depend on the type and severity of the infection, as well as the results of a pleural fluid culture.
Through a small incision in the chest wall, a plastic tube is inserted into the pleural space in order to drain the fluid and pus from the pleural space. A suction device is attached to the tube, which removes fluid and pus from the pleural space. The tube may be left in place for several days or weeks until the fluid stops draining and the infection has cleared.
Chest tube drainage may not be effective or the pleural space may be filled with thick, solid, or fibrous material that prevents drainage. The surgery may involve:
A video-assisted thoracoscopic surgery (VATS) removes infected tissue and fluid from the pleural space using larger instruments than in thoracoscopy.
An open thoracotomy involves making a large incision in the chest wall and opening the rib cage to access the pleural space. The surgeon can then remove the infected tissue and fluid and repair any lung or pleural damage.
The best way to prevent empyema is to prevent or treat the underlying conditions that can cause it, such as pneumonia. Some preventive measures include:
Getting vaccinated against pneumococcal pneumonia and influenza, which are common causes of pneumonia and empyema
Practicing good hygiene, such as washing hands frequently, covering coughs and sneezes, and avoiding contact with sick people
Quitting smoking and avoiding exposure to secondhand smoke, which can damage the lungs and increase the risk of infection
Managing chronic conditions, such as diabetes, COPD, and bronchiectasis, which can weaken the immune system and make it harder to fight off infections
Seeking medical attention promptly if symptoms of pneumonia or empyema develop, such as fever, cough, chest pain, and shortness of breath
It is a serious condition that requires immediate medical attention. Empyema is caused by a bacterial infection that spreads from the lungs to the pleural space, compressing the lungs and causing pus to accumulate. Symptoms include chest pain, fever, cough, and breathing difficulties. Physical examinations, imaging tests, blood tests, and pleural fluid analysis are used to determine the diagnosis. Occasionally, surgery is performed along with antibiotics and chest tubes. Empyema can be prevented or treated by preventing or treating the underlying causes, such as pneumonia.
