• Empyema

    Definition

    An empyema is a pocket of pus outside the surface of the lung and the tissue that surrounds it. The fluid may build up in this space called the pleural space, and put pressure on the lungs. The pressure can make it difficult to breath and cause pain.
    The Lungs (cut-away view)
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Empyema is caused by a lung infection, usually bacterial, that has traveled out of the lung. The most common infection associated with empyema is pneumonia, especially one that is difficult to treat.
    Less often, empyema may develop after injury to lung tissue caused by chest trauma or medical procedures such as:
    • Endoscopy
    • Thoracentesis—a needle is inserted through the chest wall into the pleural space
    • Chest surgery

    Risk Factors

    Empyemas are more common in children and older people. They are also more common in men.
    Factors that may increase the risk of empyema include lung infections, such as:
    • Pneumonia (most common)
    • Bronchiectasis
    • Lung abscess
    The risk of empyema may also increase in people who have a weakened immune system, such as with HIV infection, steroid use, and cancer treatment. Risk also increases with damage to lung tissue, which can occur with:

    Symptoms

    Symptoms may include:
    • Fever, chills, and sweating
    • Productive cough
    • Chest pain
    • Fatigue
    • Difficulty breathing
    • Weight loss

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done.
    Your bodily fluids may be tested. This can be done with:
    • Blood tests
    • Thoracentesis—a sample of fluid taken from the area using a needle that is inserted through the chest wall
    Your lungs and chest wall may need to be viewed. This can be done with:
    • Chest x-ray
    • Ultrasound
    • CT scan
    • Thoracoscopy—an instrument with a camera may be inserted into the chest to view the area

    Treatment

    Treatment options include:

    Medication

    Antibiotics by IV are used to treat the infection that causes the empyema.

    Procedures

    Surgery may be need if the empyema does not resolve. This can be done using:
    • Thoracentesis—A needle is inserted in the chest wall to drain the empyema.
    • A chest tube—A tube is inserted in the chest wall to encourage the empyema to drain.
    • Video-assisted thoracoscopic surgery (minimally invasive) or thoracotomy (open procedure)—The diseased lung tissue or fluids are surgically removed from the lung tissue and spaces.

    Prevention

    To help reduce your chance of getting an empyema, seek medical help for any lung infections.

    RESOURCES

    American College of Surgeons https://www.facs.org

    Family Doctor—American Academy of Family Physicians http://www.familydoctor.org

    CANADIAN RESOURCES

    Canadian Association of Thoracic Surgeons http://www.canadianthoracicsurgeons.ca

    Health Canada https://www.canada.ca/en/health-canada.html

    References

    Empyema. NHS Choices website. Available at: http://www.nhs.uk/conditions/empyema/Pages/Introduction.aspx. Updated February 11, 2016. Accessed June 14, 2016.

    Parapneumonic effusion and empyema in adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T435308/Parapneumonic-effusion-and-empyema-in-adults. Updated November 2, 2016. Accessed September 1, 2017.

    Pleural effusion and empyema. Mount Sinai Beth Israel Hospital website. Available at: http://www.wehealny.org/services/Thoracic%5FSurgery/effusionAndEmpyema.html. Accessed September 1, 2017.

    Revision Information

    • Reviewer: EBSCO Medical Review Board James Cornell, MD
    • Review Date: 09/2017
    • Update Date: 11/18/2016
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