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Empyema

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Empyema - pleural; Pyothorax; Pleurisy - purulent

Definition

Empyema is a collection of pus in the space between the lung and the inner surface of the chest wall (pleural space).

Causes

Empyema is usually caused by an infection that spreads directly from the lung. It leads to a buildup of pus in the pleural space.

There can be 2 cups (1/2 liter) or more of infected fluid. This fluid puts pressure on the lungs.

Risk factors include:

Bacterial pneumonia
Tuberculosis
Chest surgery
Lung abscess
Trauma or injury to the chest

In rare cases, empyema can occur after thoracentesis. This is a procedure in which a needle is inserted through the chest wall to remove fluid in the pleural space for medical diagnosis or treatment.

Symptoms

Symptoms of empyema may include any of the following:

Chest pain, which worsens when you breathe in deeply (pleurisy)
Dry cough
Excessive sweating, especially night sweats
Fever and chills
General discomfort, uneasiness, or ill feeling (malaise)
Shortness of breath
Weight loss (unintentional)

Exams and Tests

Your health care provider may note decreased breath sounds or an abnormal sound (friction rub) when listening to your chest with a stethoscope (auscultation).

Tests that may be ordered include:

Chest x-ray (may require multiple positions)
CT scan of chest
Thoracentesis
Pleural fluid analysis

Treatment

The goal of treatment is to cure the infection. This involves the following:

Placing a tube in your chest to drain the pus
Giving you antibiotics to control the infection

If you have problems breathing, you may need surgery to help your lung expand properly.

Outlook (Prognosis)

When empyema complicates pneumonia, the risk for permanent lung damage and death goes up. Long-term treatment with antibiotics and drainage are needed.

In general, most people fully recover from empyema.

Possible Complications

Having empyema may lead to the following:

Pleural thickening
Reduced lung function

When to Contact a Medical Professional

Contact your provider if you develop symptoms of empyema.

Prevention

Prompt and effective treatment of lung infections may prevent some cases of empyema.

References

Broaddus VC, Light RW. Pleural effusion. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 108.

McCool FD. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 86.

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Review Date: 8/26/2023

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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