empyema

Definition

Empyema is a condition in which pus and fluid from infected tissue collects in a body cavity. The name comes from the Greek word empyein meaning pus-producing (suppurate). Empyema is most often used to refer to collections of pus in the space around the lungs (pleural cavity), but sometimes refers to similar collections in the gall bladder or the pelvic cavity. Empyema in the pleural cavity is sometimes called empyema thoracis, or empyema of the chest, to distinguish it from empyema elsewhere in the body.

Description

Empyema may have a number of causes but is most frequently a complication of pneumonia. Its development can be divided into three phases: an acute phase in which the body cavity fills with a thin fluid containing some pus; a second stage in which the fluid thickens and a fibrous, coagulation protein (fibrin) begins to accumulate within the cavity; and a third or chronic stage in which the lung or other organ is encased within a thick covering of fibrous material.

— Rebecca J. Frey

[Medieval Latin empyēma, from Greek empuēma, from empuein, to suppurate.]

The presence of pus in a cavity, hollow organ, or space (for example, the pleural cavity).

Accumulation of pus in a body cavity, particularly the presence of a purulent exudate within the pleural cavity (pyothorax). It occurs as an occasional complication of pleuritis or some other respiratory disease. Signs include dyspnea, coughing, chest pain, malaise and fever. Thoracentesis may be done to confirm the diagnosis and determine the specific causative organism. Said also of nasal sinus, joint cavity, epidural space. See also guttural pouch empyema, pyothorax.

Empyema
Classification and external resources
ICD-10	510.9
MeSH	D004653

An empyema is a collection of pus within a naturally existing anatomical cavity, such as the lung pleura. It must be differentiated from an abscess, which is a collection of pus in a newly formed cavity.

Usually an empyema starts with pneumonia, followed by a parapneumonic effusion. This effusion, which starts out sterile, then becomes infected. As the infection progresses, the thickness of the fluid increases, going from a broth type consistency to concrete. When the fluid is still free flowing, it can be treated with a thoracentesis or a chest tube. When it thickens, it can usually be treated with thoracoscopy (Video Assisted Thoracic Surgery; VATS). Once the fluid becomes thick and loculated, a formal thoracic surgical procedure called a thoracotomy with decortication is required. This involves opening the chest, taking out the fluid, peeling the thick rind of infectious material off the lung, and then inserting chest tubes while the infection clears (usually with the help of antibiotics). Chest tubes in the setting of empyema have a tendency to become clogged. Chest tube clogging in the setting of an empyema can lead to re-accumulation of pus and infected material, a worsening clinical picture, organ failure and even death. Thus managing chest tube clogging is particularly important after the treatment of an empyema.

In human medicine, empyema occurs in:

• the pleural cavity (pleural empyema)
• the uterus (pyometra)
• the appendix (appendicitis)
• the meninges (subdural empyema)
• the joints (septic arthritis)
• the gallbladder

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