Empyema is a serious medical condition characterized by the accumulation of pus within a body cavity, most commonly affecting the space surrounding the lungs. This condition demands prompt medical attention, as untreated infections can lead to severe complications.
What Empyema Is
Empyema is a collection of pus in the pleural space, the narrow area between the outer surface of the lungs and the inner lining of the chest wall. This space normally contains a small amount of fluid that helps the lungs move smoothly during breathing. When an infection spreads to this area, the fluid becomes infected, leading to pus formation.
Empyema progresses through stages. As the infection continues, the fluid thickens, and fibrous strands can form, creating pockets of pus within the pleural cavity. In later stages, this infected fluid can cause scarring on the lung’s outer layers, potentially hindering its ability to expand fully.
Identifying Empyema
Individuals with empyema often experience symptoms such as fever and chills, which can be accompanied by excessive sweating, particularly at night. Chest pain is a common complaint, sometimes described as sharp or stabbing, and it may worsen with deep breaths.
Shortness of breath and a persistent cough, which may produce pus-containing mucus, are also characteristic indications. A general feeling of unwellness, fatigue, and unintentional weight loss can also signal empyema. If these symptoms appear, especially following a respiratory infection, seek medical attention.
Causes and Who is at Risk
Empyema most frequently arises as a complication of a bacterial lung infection, with pneumonia being the primary cause. When pneumonia does not respond adequately to treatment, the infection can extend into the pleural space, leading to pus formation. Various types of bacteria can cause this infection, including Streptococcus pneumoniae and Staphylococcus aureus.
Other potential triggers for empyema include chest surgery, trauma or injury to the chest, or a lung abscess. Less commonly, infections from other parts of the body can spread to the pleural space through the bloodstream. Certain factors increase an individual’s susceptibility to developing empyema, such as having a weakened immune system, diabetes, or chronic lung diseases like bronchiectasis or chronic obstructive pulmonary disease (COPD). Older age and a history of alcohol abuse are also recognized risk factors.
Diagnosing and Treating Empyema
Diagnosis of empyema begins with a physical examination, where a healthcare provider may detect abnormal breath sounds or dullness when listening to the chest. Imaging tests visualize fluid accumulation around the lungs. A chest X-ray can show fluid in the pleural space, while a CT scan provides more detailed images of the lungs and pleura, helping to identify the extent of the infection and any pockets of pus. Ultrasound imaging can locate fluid collections and guide procedures.
A procedure called thoracentesis involves inserting a needle into the pleural space to withdraw a fluid sample. This pleural fluid is then analyzed for the presence of pus, its pH and glucose levels, and to identify the specific bacteria causing the infection through Gram stain and culture. Blood tests, including a complete blood count and C-reactive protein, help assess the body’s inflammatory response.
Treatment for empyema focuses on clearing the infection and draining the pus. Antibiotics are administered, often broad-spectrum initially, and then tailored based on culture results to target the specific bacteria. A course of antibiotics can last from two to six weeks.
Drainage of the pus is also necessary, typically through the insertion of a chest tube (thoracostomy) into the pleural space to allow fluid to flow out. In some cases, substances called fibrinolytics may be instilled into the chest tube to help break down thick pus or fibrin strands. If these methods are insufficient, surgical procedures like video-assisted thoracic surgery (VATS) or decortication may be performed to remove thick pus or scar tissue that prevents the lung from expanding.
Recovery and Preventing Recurrence
Recovery from empyema can involve a hospital stay, which may last around 19 days, requiring continued antibiotic therapy and drainage. After discharge, ongoing antibiotic treatment is necessary for several weeks. Physical therapy and breathing exercises can help restore lung function and improve overall recovery.
While most individuals recover fully from empyema, potential long-term implications can include pleural scarring or reduced lung function. In rare instances, chronic empyema can lead to irreversible damage if not adequately managed. Preventing recurrence largely involves addressing the underlying cause. Prompt and effective treatment of respiratory infections, particularly pneumonia, is important. Managing any existing health conditions that increase susceptibility, such as diabetes or a weakened immune system, also contributes to reducing the risk of empyema.