An empyema is a collection of pus within a natural body cavity, most commonly the pleural space surrounding the lungs. It is usually caused by a bacterial infection of the lungs (pneumonia).

Symptoms

Typical symptoms include fever (which may be spiking), chest pain, cough, sweating and shortness of breath.

There is a dull percussion note and reduced breath sounds on the affected side of the chest. Chest x-ray shows a pleural effusion, often with a lateral bulge and pleural thickening. Ultrasound confirms the size and location of the pocket of pus and the presence of fibrin aggegates.

Diagnosis

Diagnosis is confirmed by thoracentesis . Frank pus may be aspirated from the pleural space. The pleural fluid has a low pH, high white cell count, high protein and low glucose content.

Treatment

A chest tube is inserted to drain the pus/fluid. Intravenous antibiotics are given. If this is insufficient, surgical decortication of the pleura may be required.

Some evidence suggests that intrapleural fibrinolytic drugs may be useful, especially in children.