Empyema

An empyema is an infection in fluid that can build up around the lung. There are three phases of empyema:

  • Phase one, the exudative phase, all the fluid around the lung is liquid and easily drained.
  • Phase two, the fibrinopurulent stage, the fluid has a gelatinous component due to fibrin and develops pockets.
  • Phase three, the fluid becomes thick and a rind forms around it and on the lung.

Causes

Empyema commonly develops after a case of pneumonia.


Fluid also can build up around the lung as a result of body fluid overload related to the following: 

  • Heart failure
  • Kidney failure
  • Liver failure
  • Inflammation (rheumatoid arthritis or lupus)
  • Cancer (most commonly lung cancer or breast cancer)

In these instances, an infection may develop if you have an infection elsewhere, such as at the wound site or in the blood (bacteremia).

Symptoms

  • Fever
  • Chills
  • Chest pain, especially while inhaling
  • Loss of appetite and weight loss
  • Dizziness
  • Low blood pressure

Diagnosing Empyema

  • Chest X-ray: shows fluid around the lung
  • CT scan chest: shows how thick the fluid is around the lung and whether pockets (loculations) or a rind has formed
  • Thoracentesis: a procedure during which a small needle is placed between the ribs to remove a sample of fluid for analysis

Treatments

  • Antibiotics
    • Four to six weeks of intravenous antibiotics may clear the infection.
  • Nonsurgical chest drain
    • A drain is placed in the fluid for evacuation.
    • If the fluid is in pockets, medication called proteolytics can break up the pockets.
  • Surgical drainage
    • If the empyema cannot be adequately drained by a chest tube and dissolving agents, then surgery is necessary.
    • The goal of surgery is to remove all the infected fluid and ensure the lung expands fully to fill the chest cavity.
    • Surgery can be minimally invasive (thoracoscopy or video-assisted thoracic surgery known as VATS) or open (thoracotomy).