Causes and risk factors
In most cases, empyema is due to pneumonia, which can lead to pleurisy with pleural effusion; when it appears pus, it is empyema. Empyema can also be a complication of surgery. People get sick when the immune system is unable to respond effectively to an infection, either because it is less effective or because the germ that causes the infection is especially dangerous.
This disease can be affected by representatives of both sexes of any age. Children can also be at risk. Most affected are patients with weakened immune defenses, such as patients undergoing chemotherapy, patients with immunological diseases, or patients with acquired immunodeficiency syndrome.
Which are the symptoms?
Symptoms are nonspecific; you may have a fever, cough with phlegm, difficulty breathing, high white blood cells, and inflammatory indices such as ESR and CRP. Pleural effusion is recognized on a chest x-ray. The drained fluid has a purulent character.
This happens in three stages, one after the other:
How is it diagnosed?
Chest X-ray and contrast-enhanced chest CT. Chest computed tomography is not always necessary in children because chest ultrasound can be used to monitor the development of effusion.
How is it treated?
In the exudate stage, empyema is treated with a drain placed in the pleural space so that the pleural space can be emptied of pus. At the next stage, the fluid begins to self-organize, forming concameras, in this case, thoracoscopic intervention is required to clean the pleural cavity. In the last stage, the lung is captured by the overlying visceral pleura, which becomes thick and stiff and does not allow adequate expansion. In this case, an operation with opening the chest (thoracotomy) is required, which allows to completely clear the pleural cavity and decortication of the lung, that is, remove the thick layer that captures it. Adequate intravenous antibiotic therapy is indicated at all three stages. The patient with this treatment was completely cured of the disease without consequences.
Complications of empyema can be pulmonary fibrosis, chest wall deformation, spontaneous drainage of empyema through the skin (empyema needitatis) or through the bronchus (fistola bronco-pleurica).