CCRN Empyema

CCRN Empyema Overview

Empyema is also called pyothorax or purulent pleuritis. It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space. Pus is a fluid that’s filled with immune cells, dead cells, and bacteria. Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.

Empyema usually develops after pneumonia, which is an infection of the lung tissue.

Signs and Symptoms

• having a case of pneumonia that does not improve
• a fever
• chest pain
• a cough
• pus in mucus
• difficulty breathing
• a crackling sound from the chest
• decreased breathing sounds
• dullness when tapping chest
• fluid in the lungs (visible with a chest X-ray)

Causes

Pneumonia is the most common cause of empyema. People who have undergone thoracotomies, or chest surgeries, might also be at risk of developing empyema if bacteria get into the wound.

Risk Factors

• being older than 70
• having been in the hospital recently
• having had chest surgery or trauma
• diabetes
• heart disease
• previous cancer
• chronic obstructive pulmonary disorder (COPD)
• intravenous drug use (in simple empyema cases)

Treatment

Treatment is aimed at removing the pus and fluid from the pleura and treating the infection. Antibiotics are used to treat the underlying infection. The specific type of antibiotic depends on what type of bacteria is causing the infection.

The method used to drain the pus depends on the stage of the empyema.

In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneous thoracentesis.

In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually performed under anesthesia in an operating room. There are different types of surgery for this: