Empyema Thoracis

What About Blood?
Blood in the pleural space is called hemothorax, and it usually is the result of a chest injury. Unlike empyema thoracis, hemothorax does not trigger an excessive accumulation of fluid. But like empyema thoracis, treatment is a thoracentesis—a draining of the contaminated pleural fluid. The procedure is an easy one since blood doesn’t clot in the pleural space.

What is Empyema Thoracis?

Empyema thoracis is the accumulation of pus in the pleural space—the narrow cavity between the lungs and chest wall that contains lubricating pleural fluid. The cavity is lined by two membranes—one around the lungs, one against the chest wall—that together are called the pleura. Empyema thoracis results from an infection in the lungs or some other local tissue. It can be caused by a variety of illnesses, but most often it’s a complication of pneumonia.

In addition to the dangers this condition presents in terms of a spreading infection, the patient also experiences increased breathing difficulties. Empyema thoracis can be life threatening. It is more common among the elderly.

The Mechanics of Empyema Thoracis

When pus from a nearby infection arrives in the cavity surrounding the lungs, it infects the pleural membranes covering the lungs and lining the chest wall. As the body attempts to fight off the infection, the cavity starts filling up with pleural fluid, pus and dead pleura cells. Sometimes the amount of fluid can reach a pint or more, which puts a lot of pressure on the lungs and chest wall. Not only does this lead to shortness of breath, but it raises the possibility of a rupture of the pleura and the spreading of the infected fluid to other parts of the body.

Empyema thoracis can be divided into three phases. In the initial phase, known as the acute phase, the pleural cavity fills with an abnormal amount of pleural fluid containing some pus from the infectious condition. The second phase is marked by a thickening of the fluid and the accumulation of fibrin—a fibrous, protein-based coagulant—in the cavity. Finally, if left untreated, in the third or chronic phase the lung begins to be encased in a thick fiberous material.

Symptoms of Empyema Thoracis

Symptoms are often the same as those associated with pneumonia. They include:

Fever
Cough
Shortness of breath
Chest pain
Night sweats
Dehydration
Unintended weight loss
General discomfort or uneasiness

In more progressive cases, the patient might develop very bad breath, or cough up bloody or offensive-looking sputum with a strong fetid odor.

Causes of Empyema Thoracis

Empyema thoracis can develop from a number of different organisms, such as bacteria, fungi or amebas. These organisms can be introduced into the body as a result of:

Pneumonia
A chest wound
Chest surgery
A lung abscess
A ruptured esophagus
Teeth in very poor condition
A seizure
Alcohol abuse
Poor gag reflex (inability to protect the airway)

An infection can enter the pleural cavity via the bloodstream, in the secretions of a lung abscess, on the object that caused the chest wound, or even from the surfaces of surgical instruments.

Diagnosing Empyema Thoracis

There are numerous procedures at a doctor’s disposal to develop a diagnosis. They include:

Listening to the sound of the patient’s breathing with a stethoscope
Tapping on the patient’s chest and listening for a dull sound (indicating a fluid build-up)
Taking an x-ray to reveal the make-up and condition of the chest area
Performing a CT (computed tomography) scan to obtain additional “internal” details
Drawing fluid from the chest cavity by needle (thoracentesis) and analyzing its contents
Viewing the pleural space using a thoracoscope to examine its characteristics

The most reliable diagnostic test, however, is obtaining and analyzing a sample of the fluid in the pleural cavity. The doctor can both confirm that the condition is empyema thoracis and determine the phase of the ailment.

Treating Empyema Thoracis

The goals of treatment are to cure the underlying infection that’s producing the pus, and to remove the contaminated fluid. Antibiotics are prescribed to fight the infection. The process used to extract a fluid sample for diagnostic purposes (thoracentesis) is used to drain all the accumulated fluid. In the later stages of empyema thoracis, surgery might be required to close up the space left by the fluid or to peel away the thick coating on the lungs.

In most cases, it will be necessary to redrain the cavity one or more times. For that reason, the doctor probably will install a catheter—a more permanent drainage apparatus—during the initial draining session. The number of times the cavity is drained depends largely on the effectiveness of the antibiotics, the status of the underlying condition.