Empyema symptoms, causes, and treatment

One empyema is a collection of pus in the pleural cavity, which is the area between the membranes that line the lungs. This condition is also sometimes called pleurisy, pleural infection, purulent pleurisy, or thoracic empyema.

It usually occurs as a complication of pneumonia and can occur after thoracentesis, lung surgery, lung abscess, or chest trauma.

it is most often caused by an infection Streptococcus or staphylococcus germ. Symptoms may include fever and chills, chest pain, cough and/or shortness of breath.

Diagnosis can be made with a chest X-ray or CT scan of the chest, and a thoracentesis (using a needle to collect fluid in the pleural cavity) can be done to determine the type of bacteria that caused the infection. Treatment includes a combination of antibiotics to treat the infection and placement of a chest tube to drain fluid, but surgery may be required to remove the scar tissue and part of the pleura (membrane tissue) involved in the infection.


The pleural cavity is located between the visceral pleura (the membrane on the outside of the lungs) and the parietal pleura (the membrane on the inside of the chest wall).

Typically, this area contains the equivalent of several teaspoons of pleural fluid. A normal pleural effusion is thin and translucent. Empyema has a cloudy and thick appearance.

  • When there is excess fluid in the pleural space, it is called a pleural effusion.
  • With empyema, the area may contain a pint or more of infected pus-like pleural effusion.


The fluid in an empyema contains a combination of bacteria, dead cells, and white blood cells.The most common bacteria that cause empyema are Streptococcus Streptococcus pneumoniae (bacteria that cause pneumonia) and Staphylococcus aureus.

signs and symptoms

Signs and symptoms of empyema are caused by infection and Pressure on the lungs and chest due to increased fluid in the pleural space.

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Common signs and symptoms include:

  • fever and chills
  • night sweats
  • chest pain, usually severe and worse with inspiration
  • shortness of breath
  • dry cough
  • If there is associated pneumonia, expectoration
  • decreased appetite
  • fatigue
  • general feeling of physical discomfort

Sometimes the fluid buildup can irritate the diaphragm and phrenic nerve in the area, causing hiccups.


There are many different conditions that can lead to the development of an empyema.

Some of these include:

  • Pneumonia is the most common cause of empyema,
  • Chest trauma, falls, motor vehicle accidents, or other injuries can contaminate the pleural cavity.
  • Surgery on the chest, such as lung cancer or heart surgery, can pierce the pleura.
  • Thoracentesis or chest tube placement involves a small incision in the pleura.
  • A bronchopleural fistula is a duct that may form between the pleural cavity and the bronchi, allowing bacteria to enter the pleural cavity from the bronchi. It is most common in severe necrotizing pneumonia.
  • Infection of the abdomen (peritonitis) or the area between the lungs (mediastinum) may spread to the pleural cavity,
  • Lung abscesses can rupture into the pleural space.

risk factor

Empyema is more likely to occur in people with one or more of the following conditions

  • diabetes
  • history of alcoholism
  • autoimmune diseases, such as rheumatoid arthritis
  • A suppressed immune system, such as chemotherapy
  • Lung diseases, such as chronic obstructive pulmonary disease and chronic bronchitis
  • Gastroesophageal reflux disease

That is, the presence of these risk factors is not required to develop an empyema.


Your medical history can help determine if you have risk factors for developing an empyema. If you have empyema, breath sounds may be diminished on physical examination.

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Signs of empyema can be seen on a chest X-ray or a computed tomography (CT) scan of the chest, and sometimes an ultrasound.


While imaging studies may suggest a diagnosis, a sample of fluid in the pleural space is needed to confirm the diagnosis and help choose appropriate treatment.

During thoracentesis, a long, thin needle is passed through the chest wall and into the pleural cavity. A fluid sample is taken and excess fluid is usually drained. If a lot of fluid is present, symptoms usually improve after the fluid is drained.

The obtained liquid is sent to the laboratory for analysis. Cultures are performed to isolate the specific bacteria involved and to determine the best antibiotic choice for treating the infection.

treatment solutions

Treatment of empyema requires removal of fluid and treatment of the underlying process.

fluid removal

The fluid is usually removed by thoracentesis during the diagnosis of empyema. Sometimes this is simple, especially if the empyema has not been present for a long time. A chest tube can be placed to continue draining fluid.

When an empyema appears for some time, it may become enveloped. This happens when scar tissue forms and separates the fluid into separate cavities. This makes draining fluid more difficult, sometimes requiring multiple thoracentesis to remove fluid from different compartments.

treat infection

Start antibiotics for the most likely cause of empyema immediately after a suspected diagnosis. At the same time, perform diagnostic tests.


For empyema, especially one that has been present for some time, scar tissue may form. The surgeon may need to remove some scar tissue and part of the pleura to resolve the infection. This can be done with thoracotomy (open lung surgery) or thoracoscopic surgery (minimally invasive lung surgery), with video-assisted thoracoscopic peeling being an effective and less invasive option for many people.

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A serious potential complication of empyema is sepsis – a systemic infection.


An empyema is an area of ​​infected pleural fluid around the lungs. It causes fever, shortness of breath, chest pain, and a feeling of general malaise. The most common cause is pneumonia, but other conditions, including surgery and trauma, can also cause pneumonia. Treatment includes fluid removal and antibiotics to treat the infection.

VigorTip words

If you or a loved one develops an empyema, you must know that it is treatable. When the fluid is drained and antibiotics are started, you should start to notice an improvement in your symptoms. Full recovery can take time, and it’s important to be consistent with any breathing treatments your doctor recommends (such as breathing exercises) as you recover.

Frequently Asked Questions

  • What is pleural effusion?

    Pleural effusion is the accumulation of excess fluid in the pleural space, which can cause breathing restrictions. The pleural cavity is a tiny space located between the pleura, a thin, double-layered membrane that surrounds the lungs.

    Empyema involves infected pus-like fluid, while pleural effusion is the accumulation of uninfected fluid.

    understand more:

    Pleural cavity disease

  • How to treat empyema?

    Empyema is treated with thoracentesis, a medical procedure in which a needle is used to sample and drain fluid around the lungs. After that, drainage can be continued using a chest tube. Doctors will give antibiotics to control the infection. It is also important to identify and treat the underlying cause of empyema.