EMmedonline

• Empyema is pus in the pleural space .

• It includes pleural space infections without pleural fluid sampling.

Predisposing factors :

• Aspiration pneumonia

• Associated risk factors such as neurologic disease impairing normal swallowing , respiratory disease impairing cilirary function , immunocompromised and alcoholism.

Clinical Feature

• Fever, cough, dyspnea, pleuritic chest pain & malaise.

• Decreased breath sounds , dullness to percussion, decreased tactile fremitus or frictional rub

• Rales or ronchi may be heard if there is a pulmonary infection.

Diagnosis

• Aspiration of grossly purulent material on thoracocentesis

And atleast one of the following

• Positive gram stain or culture

• Pleural fluid glucose <40 mg /dl

• pH< 7.1 or LDH > 1000 IU/L

Treatment

• Analgesic

• Piperacillin tazobactam , vancomycin if MRSA is suspected.

• Chest tube thoracostomy

• Intrapleural fibrinolytic agent may be used in fibropurulent stage like streptokinase or urokinase.

• Decortication to be considered if above are ineffective.

Updated on1/2 /2012

Reference

• Tintinalli