Empyema Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Empyema is a condition in which there is a collection of pus or pus in the pleural space. This area is located between the lungs and the inner surface of the chest wall.
Pus is a fluid that contains immune cells, dead cells, and bacteria. Pus that is in the pleural space cannot be removed by coughing but must use a needle or a surgical procedure.
Empyema can occur after a person has pneumonia, which is an infection of the lung tissue.
Symptoms
Empyema can be divided into two, namely simple empyema and complex empyema. Simple empyema generally occurs at this stage of the disease. In this type, the pus that is formed can flow freely.
Signs and symptoms of a simple empyema include:
- Hard to breathe
- Dry cough
- Fever
- Excessive sweat production
- Chest pain on breathing, with a stabbing quality
- Headache
- Confusion
- Decreased appetite
Complex empyema may occur in the later stages of the disease. In complex empyema, the inflammation that occurs can be more severe. Scar tissue can form and the chest cavity can split into smaller cavities. This is called flocculation and can be more difficult to treat.
If the infection continues to get worse, it can cause the formation of a thick lining on the pleura, which is called a pleural peel. This condition can prevent the lungs from expanding and will require a surgical procedure.
Other signs and symptoms that may occur with complex empyema include:
- Difficulty breathing
- Decreased breath sounds
- Weight loss
- Chest pain
Reason
Empyema can occur after a person has pneumonia. There are many types of bacteria that can cause pneumonia. But there are two that are most often the cause, namely Streptococcus Pneumoniae and Staphylococcus aureus.
Sometimes, empyema can occur after a person has had surgery on the chest area. This occurs due to the entry of bacteria into the pleural cavity.
Most of the pleural cavity generally contains fluid. However, infection can cause an increase in fluid volume due to the frequency of fluid production that is faster than its absorption.
These fluids can become infected with bacteria that cause pneumonia or an infection you are currently experiencing. Infected fluids also generally experience thickening. As a result, the lining of the lung and chest cavity can stick together and form a sac, which then becomes an empyema.
In patients with this condition, the lungs will have difficulty expanding completely, which then causes breathing problems.
Diagnosis
The diagnosis of empyema can be determined based on the results of a detailed medical interview, direct physical examination, and certain supporting examinations.
Doctors may suspect empyema in people with pneumonia who do not respond well to therapy. The doctor will also listen for abnormal breath sounds from the lungs using a stethoscope.
Several supporting examinations or procedures that can be performed to establish a diagnosis are:
- X-ray examination using X-rays or computerized tomography (CT) scans, which can show the presence or absence of fluid in the pleural cavity.
- Ultrasound examination of the chest wall, which can show the amount of fluid and its location.
- Blood tests, which can help evaluate the white blood cell count, look for the presence of C-reactive protein and identify the presence of bacteria causing the infection. The white blood cell count may increase in individuals who have a bacterial infection.
- Thoracentesis procedure, which can be done by inserting a needle from the back of the chest cavity into the pleural space to take a fluid sample. The fluid is then analyzed under a microscope to evaluate for the presence of bacteria, protein, and other cells.
Treatment
Empyema treatment is aimed at removing pus and fluid from the pleura and treating infection. Doctors can also prescribe antibiotics to treat infections that are the initial cause of this condition. The specific type of antibiotic given depends on the type of bacteria causing the infection.
The method used to evacuate pus depends on the severity of the empyema you are experiencing. In simple cases, a needle may be inserted into the pleural space to evacuate the fluid, which is known as percutaneous thoracentesis.
In more advanced stages or complex empyema, a drainage tube must be used to evacuate pus. This procedure is generally performed under anesthesia in the operating room, and there are a number of different surgical techniques that can be performed.
Prevention
Empyema is often preceded by an infection in the lungs or pneumonia. Therefore empyema conditions can be prevented by early detection and treatment of patients with pneumonia.