Empyema
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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.