Empyema

Home
Cardiothoracic
Lung & Chest
Conditions
Empyema

Condition

Empyema

Empyema is a condition where pus builds up in the pleural cavity, which is the area between the lung and the chest wall. This condition often develops as a complication of pneumonia, infections, or other inflammatory processes in the lungs. The presence of pus can lead to thickening of the pleura and may impair respiratory function if not treated promptly.

What are the Symptoms of Empyema?

The symptoms of empyema can vary depending on the severity of the condition, but common signs include:

Chest pain: Often sharp and worsens with breathing or coughing.
Cough: Persistent cough that may produce phlegm,.
Fever and chills: Indicating an infection.
Shortness of breath: Difficulty breathing due to the pressure of fluid in the pleural space.
Fatigue: General feelings of tiredness or weakness.

What is the Difference Between Empyema and Pleural Effusion?

While both empyema and pleural effusion involve fluid accumulation in the pleural cavity, they differ primarily in the nature of the fluid:

Empyema: Empyema occurs when infected fluid, or pus, collects in the pleural space, typically as a result of an underlying infection.
Pleural Effusion: Refers to any excess fluid in the pleural cavity, which can be serous (clear) or hemorrhagic (bloody), and is not necessarily infected. Causes of pleural effusion include heart failure, liver cirrhosis, and malignancies.

Understanding these distinctions is important for diagnosis and treatment planning, as management strategies may differ significantly between empyema and other types of pleural effusions.

What Causes Empyema?

Empyema usually arises from an infection or inflammation in the lungs, with the most common causes being:

Bacterial pneumonia

The most frequent cause of empyema, particularly in severe cases.

Lung abscess

Pus-filled cavities in the lung tissue can lead to empyema.

Tuberculosis

Can result in empyema due to inflammation and infection.

Post-surgical complications

Following chest or abdominal surgery, empyema can develop as a complication.

Injuries

Trauma to the chest can lead to infections resulting in empyema.

How is Empyema Diagnosed?

Diagnosing empyema typically involves a combination of the following methods:

Physical examination

The doctor will check for signs of fluid accumulation and listen to the lungs with a stethoscope.

Imaging tests

Chest X-rays and CT scans help visualise the pleural space and identify fluid levels.

Thoracentesis

A procedure where a needle is inserted into the pleural cavity to collect fluid for laboratory analysis, helping to determine the cause of the empyema.

What is the Treatment for Empyema?

Treatment for empyema depends on its severity and may include:

Antibiotics

These are needed for treating the underlying infection. Broad-spectrum antibiotics are often started immediately, and adjustments are made based on culture results.

Drainage

If fluid accumulation in the pleural cavity is significant, a chest tube may be placed to facilitate continuous drainage of pus and fluid. This procedure, known as thoracostomy, involves inserting a flexible tube into the pleural space through a small incision in the chest wall. By allowing the infected fluid to escape, drainage can help relieve symptoms such as chest pain and difficulty breathing, while also improving lung function and reducing the risk of further complications.

Video-assisted thoracoscopic surgery (VATS)

When drainage alone is ineffective or if the empyema is complicated, video-assisted thoracoscopic surgery (VATS) may be performed. This minimally invasive surgical technique involves the use of a small camera (thoracoscope) and instruments inserted through tiny incisions in the chest wall. VATS allows surgeons to directly visualise the pleural cavity, facilitating the removal of thickened pleura, necrotic tissue, or residual pus. The procedure is associated with reduced recovery times, less postoperative pain, and shorter hospital stays compared to traditional open surgery, enhancing overall recovery.

Decortication

In cases where the pleura become fibrous and restrict lung expansion, surgical decortication may be necessary. This procedure involves surgically removing the fibrous layer surrounding the lungs (the pleura) to allow for better lung expansion and function. By removing the thickened tissue, decortication can help restore normal lung mechanics and improve the patient’s ability to breathe. This procedure is often considered when other treatments have failed, and the patient’s quality of life is significantly impacted by restrictive lung disease due to empyema.

Empyema Treatment in Singapore

If you or a loved one is experiencing symptoms of empyema, timely treatment is essential. At O2 Lung Centre, our team comprises specialised cardiothoracic surgeons with deep expertise and advanced training to deliver comprehensive and personalised care for patients from diagnosis to advanced treatments like VATS and decortication.

For more information or to schedule a consultation, WhatsApp us at our Gleneagles Hospital clinic or Mount Elizabeth Orchard Hospital clinic today. We are here to guide you through your treatment options for better respiratory health.