Empyema: Symptoms, Types & Causes

Empyema is a serious health condition characterized by the accumulation of pus in the pleural space, a gap located between the lung and the chest wall. It often indicates a bacterial infection or inflammation within this vital area of your body.

This condition disrupts normal lung function and requires timely diagnosis and treatment, so knowing the early signs and causes of empyema is crucial.

If you suspect that you or someone you know might be experiencing symptoms related to empyema, it’s essential to seek medical attention. A healthcare professional can facilitate and provide a precise diagnosis and suggest a suitable treatment approach.

Understanding the Pleural Space

The pleural space, or the pleural cavity, is a critical, thin gap between the lung’s outer surface and the inner chest wall, filled with a small amount of lubricating fluid that facilitates smooth lung movement during breathing.

This space, typically sterile, plays a vital role in lung function, allowing the lungs to expand and contract without friction. Empyema results from the infection and inflammation of the pleural space, causing the pleura to thicken and become less flexible, which can severely restrict and impair lung function.

This condition influences breathing challenges that lead to restricted lung expansion and reduced oxygen intake, manifesting as different signs and symptoms, significantly limiting work, social interactions, and hobbies.

Causes of Empyema

Empyema develops when pus accumulates in the pleural space, usually due to an infection spreading from the lungs. Identifying the underlying cause is critical for effective treatment and prevention of recurrence.

Pneumonia

Pneumonia is an infection of the lungs that may result from various pathogens, including fungi, viruses (like influenza and SARS-CoV-2), bacteria (such as Streptococcus pneumoniae and Mycoplasma pneumoniae), as well as some parasites.

This condition inflames lung air sacs, possibly filling them with fluid or pus, which can then spread to the pleural space, causing empyema. The infected pleural fluid accumulates as the body attempts to fight off the infection around the area.

Chest Trauma or Surgery

Any type of chest trauma, inducing blunt and puncture wounds, as well as procedures like lung biopsies or thoracentesis, can lead to empyema.

These incidents could result in a breach and injure the protective layers of lung tissue, inducing the infection of the pleural space.

Weak Immune System

A weakened immune system caused by conditions like HIV, chemotherapy, or long-term corticosteroid use can make you more susceptible to infections. Cancer, particularly when involving lung or pleural tumors or as a side effect of treatments, further exacerbates this risk by obstructing lymphatic drainage or compromising lung health.

Your immune system mainly plays the role of combating harmful bacteria and viruses. When compromised, your risk of developing various infections increases, which can result in empyema if it spreads into the pleural space.

Long-Term Diseases

Chronic conditions like diabetes, heart disease, or COPD (Chronic obstructive pulmonary disease) can make you more susceptible to developing empyema. These diseases can weaken your overall immunity, making it easier for bacterial infections to take hold.

Additionally, those living with chronic diseases typically have lowered lung functionality, which can hinder the body’s ability to fight off infection, and they have a higher risk of developing this condition as a complication.

Other Types of Infections

Besides lung infections, other infections in your body can also cause empyema. These might include bloodstream infections, where bacteria enter and infect your lungs, or abdominal infections, where bacteria spread upward into your chest cavity.

Such immune responses to any infection might trigger pus accumulation in your pleural space in an attempt by the body to combat the underlying illness.

Signs and Symptoms of Empyema

Empyema affects the pleural space and respiratory health, with symptoms varying by infection stage and severity. Understanding these signs enables prompt diagnosis and helps avert complications.

Fever and Chills

When you have empyema, your body responds to the infection by raising your body temperature, leading to fever, often accompanied by chills. These symptoms are common responses that indicate your immune system is actively working to combat the invading pathogens.

A person who has recently recovered from pneumonia but then develops a sudden fever and chills might be experiencing the onset of pus developing in the pleural space.

Chest Pain and Cough

Empyema causes inflammation in the pleural space, causing acute chest pain that intensifies when coughing or taking deep breaths due to pressure and friction against the inflamed pleura. A cough may be your body’s attempt to clear the infection from the lungs and airways.

It may be continuous and could generate phlegm in some cases, reflecting the ongoing battle against the disease within your respiratory system. This symptom may intensify chest pain and discomfort as the added pressure aggravates the inflamed pleural space.

Difficulty Breathing

The buildup of pus in the pleural space restricts lung expansion, leading to shortness of breath, as your lungs cannot breathe as much air with each breath. An example of this is when someone can only breathe comfortably when sitting upright, which is especially noticeable at night.

The effort required to breathe can increase to compensate for the oxygen requirements, making even simple activities exhausting. Individuals might notice themselves gasping for air after minimal physical activity or not being able to catch their breath when attempting simple tasks, such as climbing stairs.

Fatigue

Battling an infection like empyema requires a significant amount of energy, leading to feelings of fatigue and weakness. Your body directs resources toward fighting the disease, leaving less energy for daily activities.

For example, individuals may need more time to perform simple tasks like making a meal or taking a short walk, which they could easily handle before. This symptom can be compounded by poor sleep quality due to fever, night sweats, and discomfort from other symptoms.

Excessive Sweating

Excessive sweating, particularly night sweats, can occur as your body attempts to regulate its temperature. For example, a person might find their sleepwear and bedding drenched in sweat despite a cool environment, a condition often coupled with a high fever.

This perspiration level is uncomfortable and a clear sign of the body’s response to a severe infection within the pleural cavity. Sweating is a natural method the body uses to cool down, leading to significant discomfort and sleep disturbances.

Confusion

In severe cases of empyema, confusion may arise, especially if the infection leads to sepsis or insufficient oxygenation due to difficulty breathing. For instance, an ordinarily clear-headed person might begin to exhibit signs of disorientation or difficulty focusing, signaling a potential escalation of their condition.

This symptom mainly concerns elderly patients, those with chronic obstructive pulmonary disease, or those with compromised immune systems.

Weight Loss

Unintentional weight loss can happen with empyema due to decreased appetite, the body’s increased metabolic demand to fight the infection, and the energy expenditure associated with fever and other symptoms.

When your body is focused on battling a severe infection, normal processes like eating can become secondary due to the discomfort experienced, leading to weight loss.

Increased Heart Rate

An increased heart rate, or tachycardia, is a response to fever, infection, and increased breathing effort. Your heart exerts more effort to circulate blood and supply oxygen and nutrients to tissues, including those combating the infection.

Empyema Diagnosis

Understanding empyema’s diagnostic criteria and complexities is crucial for healthcare professionals to accurately diagnose and initiate the appropriate treatment.

Medical History and Physical Examination

Gathering an extensive medical history and carrying out a physical exam are crucial first steps in diagnosing empyema. These actions reveal risk factors like recent pneumonia or chest injuries and symptoms that suggest pleural infection, directing the next steps in diagnosis.

The physical examination involves specific evaluations like auscultation, where a stethoscope is used to listen for abnormal lung sounds and palpation to detect areas of tenderness or reduced movement in the chest wall.

Chest X-Ray

A chest X-ray is frequently the initial diagnostic test used for suspected empyema. This imaging method offers a detailed image of your lungs and the pleural space, allowing doctors to see any abnormalities, including fluid accumulation.

This procedure can also help identify underlying causes, such as pneumonia, that may have led to the development of this condition. While not definitive, it provides critical early clues that guide further diagnostic steps for a more detailed examination.

Ultrasound Imaging

Chest ultrasound is a convenient, minimal-risk, non-invasive method that employs sound waves to generate images of the chest’s internal structures, including the pleural space.

Its ability to visualize the pleural layers and the exact amount and location of fluid accumulation makes it invaluable, especially in cases where the fluid’s nature needs to be assessed with precision. Furthermore, it can help guide the placement of needles for procedures to drain the fluid.

Detailed Imaging Scan

A Computed Tomography (CT) scan provides a more detailed cross-sectional image of your chest compared to a standard X-ray. This procedure diagnoses this condition by showing pleural thickness and pockets of fluid.

Furthermore, the detailed resolution of CT imaging significantly enhances the ability to differentiate empyema from conditions with similar symptoms or lung structure abnormalities, like pleural tumors or lung abscesses.

Fluid Analysis

Pleural fluid analysis is a critical diagnostic tool in confirming empyema, as it allows for directly examining the fluid characteristics that indicate infection.

The collected fluid from the performed diagnostic procedures is then sent to a laboratory, where parameters are evaluated through Gram staining to identify the underlying cause of the accumulation.

Blood Tests

Blood tests are a fundamental part of diagnosing empyema, as they can indicate the presence of an infection through markers such as higher white blood cell count and elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Blood cultures will also be performed to pinpoint the specific bacteria causing the infection, which is critical for selecting the most effective antibiotic treatment.

Chest Space Tissue Sampling

A pleural biopsy entails the removal of a small tissue sample from the pleura, which is then examined under a microscope for diagnostic purposes. It can provide definitive evidence of empyema by showing infection or inflammation in the pleural tissue.

This procedure can detect rare infections or cancers, enabling healthcare providers to customize treatments according to the identified pathogens or conditions. It is often reserved as a last resort, particularly when the diagnosis remains unclear after less invasive methods are used.

Clinical Treatments

Treatment and management of empyema focus on eradicating the infection and removing the infected pleural fluid. Understanding available treatments helps one make informed decisions.

Antibiotics and IV Therapy

Antibiotics serve as the fundamental treatment for empyema. They specifically target the bacteria that lead to the buildup of pus in the pleural space. For example, if the infection is due to typical pneumonia-causing bacteria, broad-spectrum antibiotic treatment may be initiated and adjusted based on culture results.

IV therapy is the preferred initial method for severe infections, delivering antibiotics and fluids directly into the bloodstream for a more efficient treatment. Once stabilized, patients may transition to oral antibiotics to complete their course of treatment, ensuring the infection is fully resolved and symptoms are reduced.

Local Needle Drain

Thoracentesis is when a needle is inserted into the pleural space to drain infected fluid, easing symptoms like breathlessness and chest pain and allowing fluid analysis for precise antibiotic therapy.

In some cases, thoracentesis is performed multiple times to remove fluid if it continues to accumulate. Laboratory analysis of the aspirated fluid can reveal the presence of infection through bacterial cultures, leukocyte levels, and chemical composition, offering conclusive evidence of empyema’s cause.

Chest Tube Drainage

For cases where empyema involves a significant amount of fluid or if the pus is thick, chest tube drainage may be necessary to drain the infected fluid from the chest wall.

The chest drain may remain in place for several days until the fluid production stops to ensure complete drainage, promoting lung re-expansion and recovery.

Managing Underlying Conditions

Effectively managing underlying conditions that lead to empyema, such as bacterial pneumonia, autoimmune diseases, or surgery complications, is essential for a comprehensive treatment plan.

By targeting these root causes, healthcare providers can directly influence the course of this condition, enhancing the effectiveness of treatments like antibiotics or surgical interventions to clear the infection and drain the pleural space.

Supportive Care

Supportive care for empyema patients includes administering pain relievers to manage chest discomfort and prescribing anti-fever medications to reduce high temperatures, making the recovery process more comfortable for the patient.

Incorporating practices like incentive spirometry to encourage deep breathing can enhance lung capacity. This aids in preventing complications and promoting lung expansion, which is crucial for clearing pleural fluid and facilitating recovery.

Nutritional support is also critical, as a well-balanced diet enriched with vitamins and minerals can bolster the immune system, enhancing the patient’s capacity to fight off the infection.

Oxygen therapy might be administered to those experiencing significant breathing difficulties, ensuring sufficient oxygen levels are maintained.

Limiting Fluid Accumulation

Pleurodesis is a treatment option designed to prevent the recurrence of pleural effusions, including those caused by empyema. During this procedure, a chemical substance is introduced into the pleural space, causing the pleural layers to stick together and eliminating the space where fluid can accumulate.

It is often considered when there’s a high risk of recurrent empyema, effectively sealing the pleural space to prevent future fluid build-up.

Video-Assisted Surgery

Video-Assisted Thoracoscopic Surgery (VATS), a less invasive surgical method, is designed to treat empyema by allowing direct access to the pleural space through small incisions.

Surgeons can drain the infected fluid, remove pus and debris, and release fibrous adhesions using a video camera, such as a thoracoscope, along with other special instruments. VATS offers the advantage of shorter recuperation periods and reduced pain after the operation compared to traditional open surgery (thoracotomy).

Open Surgery

Thoracotomy, the most invasive empyema treatment, is reserved for severe cases with a thick peel or extensive scar tissue that less invasive methods can’t resolve. It involves opening the chest wall to reach the pleural space for thorough cleaning.

This procedure is crucial for advanced empyema, particularly fibrothorax, where thickened pleura prevents lung re-expansion. Surgeons remove pus, infected tissue, and adhesions to allow the lungs to expand properly.

Frequently Asked Questions

What causes empyema?

Empyema is primarily caused by bacterial infections that extend into the pleural space. This condition often develops as a complication of other lung infections or diseases.

The most common causes include a weak immune system, pneumonia, chest trauma or surgery, chronic diseases, and other types of infections. A compromised immune system or lowered lung functionality can elevate the risk of this condition developing.

What symptoms suggest someone might have empyema?

Symptoms of empyema can include fever and chills, chest pain, difficulty breathing, persistent cough, fatigue, confusion, excessive sweating, weight loss, increased heart rate, and low blood pressure.

However, these can differ based on the intensity of the infection. If you observe these symptoms, it’s important to seek medical advice without delay.

How is empyema diagnosed?

Empyema is diagnosed using a multifaceted approach that starts with a comprehensive review of medical history and a physical exam to assess symptoms and potential risk factors.

Imaging tests, including Chest X-rays and ultrasound, are commonly used to detect fluid in the pleural space, while a CT scan offers a more detailed image of the lungs and pleural space.

The collected fluid from the performed diagnostic procedures can allow lab analyses to confirm the presence of bacteria. Blood tests also help indicate the presence of an infection.

What are the treatment options for empyema?

Treatment for empyema generally includes a combination of medications and procedures, depending upon the severity of the condition. Antibiotics are the first line of treatment. Drainage procedures, such as a thoracentesis or chest tube drainage, help remove the infected fluid.

In severe cases, surgical procedures like a thoracotomy or Video-Assisted Thoracoscopic Surgery (VATS) may be necessary to improve lung functionality. Pleurodesis is often considered when there’s a high risk of recurrent empyema.

Additionally, managing underlying conditions like pneumonia and providing supportive care such as pain relief, nutrition, and oxygen therapy are crucial to recovery from empyema.