What is Empyema?
Empyema is a collection of pus within the pleural space. It most often develops as a complication of pneumonia but can also follow chest injury, surgery or tuberculosis.
Empyema requires timely treatment with appropriate antibiotics and drainage of the infected fluid; delayed treatment can lead to thickening of the pleura and trapping of the lung.
Common symptoms
- Persistent or recurrent fever despite antibiotics
- Chest pain
- Breathlessness
- Cough with phlegm
- Sweating, weight loss and feeling generally unwell
Possible causes & risk factors
- Bacterial pneumonia
- Tuberculosis
- Chest trauma or surgery
- Spread of infection from nearby organs
- Diabetes, alcohol use and poor dental health increase the risk
When should you consult a pulmonologist?
- Pneumonia that is not improving with antibiotics
- New or increasing fluid around the lung with fever
Diagnostic investigations
Your evaluation is tailored to your symptoms and history. It may include:
- Thoracic ultrasound and CT scan of the chest
- Pleural fluid aspiration and analysis
- Blood tests and cultures
Available treatment approaches
- Prolonged, culture-guided antibiotic therapy
- Chest tube (intercostal drain) or pigtail catheter drainage
- Intrapleural medicines to help break down loculations in selected patients
- Medical thoracoscopy in selected cases
- Referral for surgery when drainage is inadequate
Treatment is individualised. The options above are general information; your doctor will recommend what is appropriate for you after assessment. Outcomes vary from person to person.
Frequently asked questions
Antibiotics are usually needed for several weeks, and drains remain in place until the fluid has adequately cleared. Duration varies from patient to patient.
