Empyema: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Empyema?
A pulmonologist, a doctor who treats lung diseases, usually treats empyema. An infectious disease doctor may help manage the infection. A chest surgeon, a doctor who operates on the lungs and chest, may be needed to drain the pus. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is empyema?
Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall. This space is called the pleural space. Another name for it is pyothorax. The word empyema thoracis comes from Greek and means pus in the chest.
The extra fluid puts pressure on the lung. Empyema often develops as a complication of pneumonia, chest trauma, or surgery.
Symptoms
Symptoms of empyema may include:
- Chest pain that gets worse when you breathe in deeply.
- Dry cough.
- Night sweats and other heavy sweating.
- Fever and chills.
- Feeling generally unwell.
- Shortness of breath.
- Weight loss without trying.
Early symptoms are similar to pneumonia, with fever, cough, and chest pain.
Causes and who gets it
Empyema is usually caused by an infection that spreads directly from the lungs. The most common cause is bacterial pneumonia. Other risk factors include tuberculosis, chest surgery, a lung abscess, and an injury to the chest. In rare cases, it follows thoracentesis, a procedure that uses a needle to remove fluid from the pleural space.
Some other risk factors are poor oral hygiene, diabetes, liver cirrhosis, alcohol use disorder, and intravenous drug misuse. A weakened immune system is also a risk factor.
How doctors diagnose it
Your doctor may listen to your chest with a stethoscope. Breath sounds may be decreased, or there may be an abnormal rubbing sound. Tests may include a chest x-ray and a CT scan of the chest. These imaging tests make pictures of the lungs and the pleural space.
Doctors may also do thoracentesis, which uses a needle to remove fluid from the pleural space. Pleural fluid analysis is a lab test on that fluid. Fluid that looks like pus strongly suggests empyema.
Treatment
The goal of treatment is to cure the infection. This involves placing a tube in the chest to drain the pus. It also involves antibiotics, which are medicines that fight bacterial infection. Long-term treatment with antibiotics and drainage is needed.
If you have problems breathing, you may need surgery to help your lungs expand properly. Empyema can lead to pleural thickening and reduced lung function. When empyema complicates pneumonia, the risk for permanent lung damage and death goes up.
In general, most people fully recover from empyema. Prompt and effective treatment of lung infections may prevent some cases.
When to see a doctor
Contact your doctor if you develop symptoms of empyema, such as fever, chills, or a cough.
Call 911 or go to the emergency room if you have severe trouble breathing, chest pain or discomfort lasting two minutes or more, fainting, or sudden confusion or other change in mental status.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A doctor like this can check symptoms such as fever and chest pain, arrange chest imaging, and coordinate care with lung specialists. They can also follow up after treatment.
Common questions
Is empyema the same as pneumonia?
No. Empyema is pus in the space around the lung, while pneumonia is a lung infection. Empyema often develops as a complication of pneumonia.
Is empyema serious?
Yes. Empyema is described as a life-threatening infection, so early diagnosis and treatment matter. Treatment includes draining the pus and taking antibiotics.
Do people recover from empyema?
Yes, in general most people fully recover from empyema. When empyema complicates pneumonia, the risk for permanent lung damage and death goes up.
Can empyema be prevented?
Sometimes. Prompt and effective treatment of lung infections may prevent some cases of empyema.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
