Surgeon operating on empyema

In this guide, we aim to provide a detailed understanding of empyema, a potentially serious lung condition. We’ll explain what empyema is, its underlying causes, how it’s diagnosed, the available treatment options, and the measures that can be taken to prevent it.

What is Empyema?

Empyema, also known as a pleural infection, is a condition where pus accumulates in the pleural cavity—the space between the lungs and the chest wall. This condition is typically a complication of pneumonia and can lead to a wide range of symptoms, including chest pain, fever, and shortness of breath.

Understanding the Causes

Empyema is most often caused by a bacterial infection, often as a result of pneumonia or following a surgical procedure on the chest. Bacteria causing pneumonia can spread to the pleural space, causing a build-up of pus and fluid.

Common pathogens seen in empyema include Streptococcus mitis, Streptococcus pneumoniae, Staphylococcus aureus, and a variety of anaerobic bacteria. Other conditions such as a lung abscess or severe case of tuberculosis can also lead to empyema.

What are the Symptoms of Empyema?

Recognising the symptoms of empyema is critical for timely diagnosis and effective treatment. Empyema often develops as a complication of pneumonia, and as such, the symptoms of these two conditions can overlap. However, empyema can also present its own unique signs and symptoms, including:

Persistent Fever and Chills A fever is often the body’s response to an infection. If you’re suffering from empyema, you may experience a high, persistent fever accompanied by chills.

Shortness of Breath The build-up of pus and fluid in the pleural space can exert pressure on the lungs, making it harder to breathe. Shortness of breath, especially during physical activity, can be a prominent symptom of empyema.

Chest Pain Empyema can cause intense, sharp chest pain that worsens when you cough or take deep breaths. The pain may be located on one side of the chest where the empyema is present.

Persistent Cough People with empyema often have a persistent cough that produces greenish or yellowish mucus. In some cases, the cough might even bring up pus or blood.

Fatigue Empyema can cause significant fatigue. This is the body’s response to fighting off the infection and the increased effort it takes to breathe.

Night Sweats Unexplained night sweats can also be a sign of empyema. This is due to the body’s efforts to fight off the infection, leading to increased sweating.

Unintended Weight Loss In some cases, people with empyema may experience unexplained weight loss. This could be due to a combination of factors including decreased appetite and the increased energy expenditure from persistent coughing and difficulty breathing.

How is Empyema Diagnosed?

If you’re experiencing symptoms such as a persistent cough, chest pain, or difficulty breathing, seeking medical help promptly is essential. The diagnosis of empyema involves various tests, including:

Chest X-ray This imaging test helps visualise any fluid build-up in the pleural space. However, it may not be able to confirm the presence of empyema definitively.

Ultrasound or CT Scan These advanced imaging tests provide a more detailed picture of your lungs and can help differentiate empyema from other lung conditions.

Thoracentesis In this procedure, a small needle is inserted into the pleural space to withdraw fluid for testing. The collected fluid is then analysed for bacteria, which can confirm the diagnosis of empyema.

Treatment Options for Empyema

The primary goal of treating empyema is to drain the pus from the pleural space and treat the underlying infection. Treatment options generally involve a combination of medical and surgical approaches.

Medical Treatment This generally involves the use of antibiotics to combat the bacterial infection. The specific choice of antibiotics depends on the type of bacteria causing the infection.

Surgical Treatment In more severe cases, a surgical procedure known as thoracotomy may be required. This involves making an incision in the chest wall to drain the pus. However, less invasive procedures, such as video-assisted thoracoscopic surgery (VATS), are often preferred.

When to Seek Emergency Care

While empyema typically develops gradually, it can occasionally cause severe symptoms that warrant immediate medical attention. These include severe difficulty breathing, intense chest pain, or confusion. If you or a loved one experience these symptoms, seek emergency medical help.

What are the Complications of Untreated Empyema

Complications of Untreated Empyema

If empyema isn’t treated promptly, it can lead to serious complications. These can significantly impact your health and quality of life, making early detection and treatment essential. Here are some complications that can result from untreated empyema:

1. Pleural Fibrosis and Thickening Chronic empyema can cause the pleural tissues to thicken and become fibrous, making it harder for the lungs to expand and contract. This can lead to breathing difficulties and a chronic cough.

2. Septicemia If the infection spreads to the bloodstream, it can cause septicemia, a serious and potentially life-threatening condition. Septicemia can result in a range of symptoms, including high fever, rapid heartbeat, and confusion.

3. Lung Abscess A lung abscess, which is a pus-filled cavity in the lung, is another possible complication of untreated empyema. Abscesses can cause symptoms such as coughing up pus or blood, chest pain, and difficulty breathing.

4. Respiratory Failure In severe cases, untreated empyema can lead to respiratory failure. This is a condition in which the lungs can’t adequately oxygenate the blood or remove carbon dioxide. Symptoms include severe shortness of breath, rapid breathing, and a bluish colour to the skin, lips, or fingernails.

5. Disseminated Infection If the bacterial infection causing empyema is not controlled, it can spread to other parts of the body. This can lead to other serious infections, such as meningitis or endocarditis.

6. Empyema Necessitans In very rare cases, the infection can extend to the chest wall, causing a palpable mass. This condition, known as empyema necessitans, can cause severe pain and require extensive surgical treatment.

Can Empyema be Prevented?

Since empyema often results from an existing infection, the best prevention is prompt treatment of respiratory infections such as pneumonia. Regular vaccination against pneumonia and influenza can also significantly reduce the risk of developing empyema.


Empyema is a serious lung condition, but with timely diagnosis and appropriate treatment, it can be successfully managed. It’s essential to stay informed, recognise the signs, and seek medical help when necessary. Prevention plays a significant role, and maintaining good respiratory health is vital. A healthy lung is a happy lung.

This detailed guide aims to provide a comprehensive understanding of empyema. If you have concerns or questions about empyema, always remember to consult with a healthcare professional.


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Disclaimer: The information provided in this article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment.

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