'Empyema' is the medical term for pockets of pus that have collected inside a body cavity.
They canform ifa bacterial infection is left untreated, or if it fails to fully respond to treatment.
The term 'empyema' is most commonly used to refer to pus-filled pockets that develop in the pleural space. This is the slim space between the outsideof the lungs and the inside of the chest cavity.
Empyema isa serious condition which requires treatment. It can cause fever, chest pains, breathlessnessand coughing up mucussee What are the symptoms?
Although it can occasionally be life-threatening, it's not a common condition, as most bacterial infections are effectively treated with antibiotics before they get to this stage.
The lungs and inside of the chest cavity are lined with a smooth layer called the pleura. These layers are almost in contact, but separated by athin space the pleural space filled with a small amount of lubricant called pleural fluid.
The pleural fluid cansometimes build up and become infected, so that a collection of pus forms. This can thicken and cause areas of the pleura to stick together, creatingpockets of pus.
Empyema can worsen to become many more pockets of pus, withthick deposits coating the outer layer of the lungs. These deposits prevent the lungs expanding properly.
The most common cause of empyema is pneumonia caused by a bacterial infection of the lungs. An empyema can form when pneumonia fails to fully respond to treatment in a straightforward way.
Other possible causes are:
You're more at risk of developing an empyema if you:
Both adults and children can be affected.
An empyema can bedistressing and uncomfortable. It can cause:
An empyema is usually suspected when a person with severe pneumonia does not improve with treatment, and they start to show some of the above symptoms.
If the patient is coughing up mucus,a sample of this should be taken to be inspected under a microscope.Thetype of bacteria causing theinfection is identified so the most effective antibiotics can be given.
A blood sample will also be taken, to count the number of white blood cells and other markers of infection.
An X-ray or ultrasound scan will show whether there is a collection of fluid building up around the lungs and how much there is. Often a CT scan may also be used to give a more detailed assessment.
Some patients will just need antibiotics given intravenously (directly into a vein through a drip). However, they may need to stay in hospital for a long period.
Some patients may need both antibiotics and a chest drain.
A chest drain isa flexible plastic tubeinserted through the chest wall and into the affected area, to drain it of fluid. The area where the tube is inserted is numbed, and the patient may also be given a light sedative before having the drain inserted. Painkillers are given to ease any pain while the chest drain is in.
The chest tube usually stays in place until anX-ray or ultrasound scanshows all the fluid has drained from the chest and the lungs arefully expanded. Sometimes injections may be given through the chest drain to help clear the infected pockets of pus.
The patient may need to stay in hospital until the tube is removed. Some patients may be able to go home withthe chest tube still in placein which case a specialist nurse will offersupport and advice on how to manage thisat home. The nurse will demonstrate how to position, empty and change the bag, until the family or patient feels confident to do this themselves.
For more information, read this NHS factsheet on chest drains (PDF, 148kb) .
Surgery may be needed if the condition doesn't improve.This involves making an incision (cut) in the chest to access the lungs, and removing the thick layer coating the lungs, so they can expand properly again. This is only carried out if other treatments haven't worked.
Your surgeon or specialist will explain the benefits and risks of the procedure. Read more about lung surgery .
A chest drain is not suitable for all patients. Some will instead opt to have an opening made in their chest, known asa stoma.A special bag is placed over the stoma to collect the fluid that leaks from the empyema. This is worn on the body, and may be more discreet and interfere less with your lifestyle than a chest drain.
However, with modern treatments getting a stoma is uncommon.