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    Empyema

    Empyema - plural; Pyothorax; Pleurisy - purulent

    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 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:

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

    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

    • 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

    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:

    • Chest x-ray
    • CT scan of chest
    • Pleural fluid analysis
    • Thoracentesis

    Treatment

    The goal of treatment is to cure the infection. This involvesremoving 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.

    Outlook (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.

    Possible Complications

    • Pleural thickening
    • Reduced lung function

    When to Contact a Medical Professional

    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.

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      A Closer Look

        Tests for Empyema

          Review Date: 1/29/2013

          Reviewed By: 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.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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