Empyema

While empyema can occur even without these factors, the following increase the risk:

• Aspiration (inhaling food or liquid into the lungs)
• Poor dental hygiene
• Alcohol use
• Intravenous drug use
• Poor nutrition
• Age over 65 years or in young children
• Weakened immunity e.g. individuals on chemotherapy or immunosuppressants

• Shortness of breath
• Sharp chest pain, especially during deep breaths and cough
• Fever
• Cough
• Sputum

Empyema is diagnosed based on imaging and a procedure called thoracocentesis.

1. Imaging

• Chest X-ray: Often the initial test used to show fluid in the pleural space.

• CT Scan: This may be necessary if a chest X-ray is inconclusive, especially when there is little fluid or multiple pockets of collection present. It can also show any abnormalities in the lungs and adjacent structures.

• Ultrasound: Used to see if the empyema is free-flowing or in pockets, and to aid the doctor in selecting the site for thoracocentesis (see below).

2. Thoracocentesis (Fluid Sample)

• The doctor inserts a needle through the skin of the chest wall into the fluid collection to obtain a sample. Empyema is confirmed if frank pus is obtained. The fluid is also sent to the lab for further analysis and to identify the specific micro-organism causing the infection.

3. Other Tests

• Blood Tests: Performed to check for elevated white blood cells and inflammatory markers.

• Cultures: Sputum and blood cultures may be used to help establish the diagnosis.

1. Antibiotics

Your doctor will usually start you on intravenous antibiotics and will tailor the choice according to your test results.

The course of antibiotics is generally about 4 to 6 weeks, but a longer duration may be required in complicated cases. Patients may be switched to oral antibiotics as their condition improves.

2. Drainage

A chest tube is required to promptly remove the pus and control the source of infection. This involves your doctor making a small cut over the skin of the chest wall, and inserting a tube into the pleural space to allow removal of pus.

In cases where there are many pockets of pus collection, your doctor may inject agents called fibrinolytics into the pleural space via the chest tube to facilitate drainage.

Occasionally, more than one chest tube may be necessary to optimise drainage.

3. Surgery

Surgery is needed if the infection remains poorly controlled despite antibiotics and drainage.

• VATS (Video-Assisted Thoracic Surgery): The cardiothoracic surgeon will make small cuts over the chest wall to insert a camera tube and tools into the pleural space.

• Decortication: The surgeon removes abnormally thick membranes to help the lungs expand and improve drainage.

Important Note: Recovery from empyema is a gradual process. It is essential to finish the entire course of antibiotics and attend follow-up appointments to ensure the infection is completely cleared.