Empyema: Causes, Symptoms and treatment

Empyema is also known as pyothorax or purulent pleuritis. It is a state in which pus accumulates in the area between the lungs and the internal surface of the thoracic wall. This area is referred to as the pleural space. (1)

Pus is a liquid made up of immune cells, dead cells and bacteria. It’s impossible to spit pus in the pleural space. Rather, it should be drained by a needle or surgical procedure.

Empyema generally develops as a result of pneumonia, which is an infection of respiratory tissue.


Empyema may occur after pneumonia. There are many types of bacteria can cause pneumonia, but the two most commonly occurring are Streptococcus pneumoniae and Staphylococcus aureus. Occasionally, empyema can occur after you have had surgery in your chest. Medical devices may pass bacteria through your pleural cavity.

The pleural space naturally has a bit of fluid, but the infection can cause the fluid to accumulate more quickly than it can be absorbed. As a result, the liquid becomes infected with the bacteria that are responsible for pneumonia or infection. The infected liquid becomes thicker. It may cause the lining of your lungs and thoracic cavity to stick together and form pouches. That is known as an empyema. Your lungs may not be able to fully inflate, which can cause respiratory problems.

Empyema Risk factors include:

  • Chest surgery
  • Lung abscess
  • Bacterial pneumonia
  • Tuberculosis
  • Traumatic or chest injury

Conditions that put you at risk

The greatest risk factor of empyema is pneumonia. Empyema is more common in children and older adults. However, this is fairly uncommon. In one study, it affected less than 1% of children suffering from pneumonia. (1)

Having these conditions may also increase your risk for empyema after pneumonia:


Empyema can be simple or complex.

Simple empyema

Simple empyema happens at the beginning of the illness. A person gets this kind if pus flows freely. The symptoms of simple empyema include the following:

Complex empyema

The complex empyema occurs during the last stage of the disease. In complex empyema, inflammation is most serious. Scars may develop and divide the thoracic cavity into smaller ones. This is known as loculation, and it’s harder to treat.

If the infection keeps worsening, may result in thick peel forming on the pleura, called a pleural peel. This coat prevents lung expansion. Surgery is necessary to fix him.

Other symptoms associated with complex empyema include:

  • difficulty breathing
  • decrease in breathing sounds
  • weight loss
  • chest pain


In rare cases, a complex case of empyema may cause more serious complications. Among other things, it is septicaemia and pulmonary collapse, also known as pneumothorax. The symptoms of sepsis include:

A pulmonary collapse may cause sudden and acute chest pain and shortness of breath which worsens with coughing or breathing.

These conditions may be life-threatening. If you experience these symptoms, you should call 911 or ask someone to drive you to the emergency department.

Diagnosing empyema

A physician may suspect empyema if you develop pneumonia that does not respond to treatment. Your physician will take a full medical history and physical examination. They can use a stethoscope to detect any unusual noise in your lungs. (1)(2)

Your physician will generally carry out certain tests or procedures to confirm a diagnosis:

Tests that can be ordered consist of:

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


The purpose of the treatment is to eliminate pus and fluid in the pleura and to treat the infection. Antibiotics are used as a treatment for the underlying infection. The particular type of antibiotic depends on the type of bacteria that causes the infection.

The method of draining pus is dependent upon the empyema stage.

In simple cases, a needle may be inserted into the pleural space to flush out the liquid. This is known as percutaneous thoracentesis.

Various types of surgery are available for this:

  • Thoracostomy
  • Video assisted thoracic surgery
  • Open decortication

If you have respiratory problems, you may need surgical intervention to help your lung expand properly.


The viewpoint of empyéma with rapid processing is good. Long-term lung injury is not common. You might want to finish your antibiotics and get an X-ray of the chest. Your physician can ensure that your pleura has healed well.

However, in those who have other problems that affect the immune system, empyema may have such a high death rate as 40 percent. Most people are generally recovering from empyema.

If left untreated, empyema may result in potentially fatal complications such as sepsis.

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