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Empyema

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

Lungs

Causes, incidence, and risk factors

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

There can be a pint or more of infected fluid. This fluid puts pressure on the lungs.

Risk factors include:

In rare cases, empyema can occur after a needle is inserted through the chest wall to draw off fluid in the pleural space for medical diagnosis or treatment (thoracentesis ).

Symptoms

Signs and tests

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

Tests may include the following:

Treatment

The goal of treatment is to cure the infection. This involves removing the collection of pus from the space between the lung and the inner surface of the chest wall. Antibiotics are prescribed to control the infection.

The health care provider will place a chest tube to completely drain the pus. A surgeon may need to perform a procedure to peel away the lining of the lung (decortication) if the lung does not expand properly.

Expectations (prognosis)

When empyema complicates pneumonia, the risk of permanent lung damage and death goes up. Patients will need long-term treatment with antibiotics and drainage. However, most people fully recover from empyema.

Complications

  • Pleural thickening
  • Reduced lung function

Calling your health care provider

Call your health care provider if you develop symptoms of empyema.

Prevention

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

References

McCool FD. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 99.

Broaddus VC, Light RW. Pleural effusion. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 68.

Updated: 1/29/2013

Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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