What Is Empyema? What Are Its Causes, Symptoms and Treatment Methods?

In medical literature, the health condition known as empyema is briefly used to describe pus (inflammation) accumulating in body cavities. One of the most important causes of empyema is bacterial infections that are left untreated or whose treatment has failed. Empyema is generally used to describe inflammation accumulating in the narrow space between the lung and the chest cavity. The main cause of inflammation in this space is pneumonia; however, a previous chest surgery or trauma can also cause empyema. Since bacterial infections are generally treated effectively with antibiotic-class drugs, empyema is a rarely encountered condition. However, since it can cause a person's death when it occurs, the symptoms of empyema need to be carefully evaluated.

High fever, chest pain, shortness of breath and coughing up sputum can be counted among the main symptoms of empyema. Imaging techniques such as X-ray help diagnose empyema. In cases of empyema diagnosed in the early period, antibiotic treatment is often sufficient. However, in some cases, the pus accumulating in the cavities may need to be drained with a special needle or using surgical methods. The answers to questions such as “What is empyema?” and “What are its symptoms, and what are its diagnostic and treatment methods?” and other questions people wonder about regarding empyema are included in the later parts of this article.

What Is Empyema?

Empyema is a rarely encountered but serious health problem, manifested by pus accumulating in body cavities, which can lead to serious consequences if it is not diagnosed and treated in the early period. The body contains cavities such as the sinus cavity and the chest cavity. One of the cavities where empyema is most commonly encountered is the pleural cavity, also called the pleural space, which is the space between the chest wall and the lungs.

The most important cause of empyema is harmful microorganisms, primarily bacteria. Under normal conditions, when the human body encounters a foreign pathogen such as harmful bacteria, it activates immune system cells to fight it. If the immune system is insufficient in fighting bacteria, antibiotic drugs can be used under a doctor's supervision. However, these drugs may not always be sufficient against the infectious disease. In this case, inflammatory fluid can accumulate in body cavities. This accumulated fluid can lead to the progression of the infection and, consequently, to serious complications.

Treatment of empyema may vary depending on factors such as the patient's general health condition, and the location and severity of the inflammatory fluid. For specialists, the most important aspect of treatment is clearing the infection. Therefore, in simple cases, the infection can usually be treated with antibiotics. In cases where antibiotics are not sufficient, physicians may clear the inflammation in the cavity by using special needles or by resorting to different surgical methods.

What Are the Symptoms of Empyema?

The pleural cavity, located between the chest wall and the lungs, normally contains a certain amount of fluid. However, if there is any infection in the body, the production of this fluid may increase or its reabsorption may decrease. In this case, the fluid in the pleural cavity may become infected with bacteria and concentrate. In this situation, various symptoms may appear, especially shortness of breath and coughing. Empyema has two different types: simple and complex. Simple empyema occurs in the early stages of the infection. The symptoms of simple empyema are milder. Its main symptoms include shortness of breath, dry cough, fever, sweating, a stabbing sensation when breathing, headache, mental confusion and loss of appetite

Complex empyema, which appears in the later stages of the disease, involves more severe inflammation. In complex empyema, scar tissue may form in the pleural cavity. If it is not addressed in the early stage, the infection may progress and result in the formation of a thick membrane over the pleura (the membrane that lines the chest cavity from the inside). This can cause serious complications. In addition, the main symptoms of complex empyema can be listed as follows

Difficulty breathing,

Unexplained weight loss,

Chest pain,

Cough.

In addition to those listed above, complex empyema can rarely lead to more serious complications such as pneumothorax (lung collapse) and sepsis. Since symptoms such as high fever, shivering, rapid breathing, rapid heartbeat and low blood pressure may indicate sepsis, it is important to make an appointment with a doctor specialized in the field and have the necessary examinations without delay (4). If you notice symptoms listed above, such as shortness of breath or weight loss, do not neglect to apply to a healthcare facility without wasting time.

What Are the Causes of Empyema?

Empyema is a health problem that can arise from various causes, primarily pneumonia. The main causes of empyema can be listed as follows. Bronchiectasis, in which the bronchi are irreversibly damaged and the lung consequently becomes vulnerable to infections, is one of the main causes of empyema.

A blockage caused by a health problem such as embolism (a blood clot) in the blood vessels that carry blood to the lung may cause part of the lung tissue to die. As a result, the risk of inflammatory fluid accumulating in the pleural cavity may increase.

After some chest surgery operations, complications such as empyema may rarely occur.

Rarely, empyema may develop secondary to food particles entering the lungs in patients with swallowing difficulties.

Chest trauma can also cause pus to accumulate in the pleural cavity.

In addition to those listed above, diseases such as diabetes and reflux, excessive alcohol consumption, and a weakened immune system can increase the risk of empyema. Empyema can also develop secondary to a more serious health problem such as lung cancer. For this reason, if specialists deem it necessary, they may use additional tests such as biopsy (taking a sample and examining it in a laboratory) during the diagnostic stage. If you have complaints such as shortness of breath or a stabbing sensation in the chest when breathing, do not neglect to apply to a healthcare facility.

How Is Empyema Diagnosed?

In cases where no positive result is obtained from pneumonia treatment, specialists may begin a more detailed diagnostic process with suspicion of empyema. First, the patient's medical history is taken and a physical examination is performed by a doctor specialized in the field. At this stage, specialists generally use an instrument called a stethoscope to listen to abnormal sounds in the lungs. Then, imaging methods such as chest X-ray, computed tomography (CT) and ultrasonography can be used to confirm the diagnosis.

In addition, blood tests can be used to examine the patient's white blood cell count (WBC), C-reactive protein levels (CRP) and the bacteria that are the infectious agent. If the specialist detects fluid in the pleural cavity after imaging, they may request that a fluid sample be taken from the pleural cavity through a procedure called thoracentesis and analyzed in a laboratory.

How Is Empyema Treated?

The aim of treating empyema is to remove the pus and fluid accumulating in the pleura and to treat the infection. For this, specialists may first use antibiotic drugs aimed at treating the infection. Which type of antibiotic will be used varies according to the type of bacteria causing the infection. In cases where no positive result is obtained from antibiotic treatment, the inflammation in the cavity needs to be drained using various methods. The method to be used at this point is determined according to the degree of inflammation. In the early stage of empyema, the fluid in the pleural cavity can usually be drained with the help of a special needle, using a method called percutaneous thoracentesis. In more advanced stages or in complex empyema, a special drainage tube may be needed to drain the pus. Draining the fluid with the help of a special tube is generally performed under anesthesia in a sterile operating room environment. The main surgical methods that specialists use to drain the fluid are as follows

Thoracostomy: In the thoracostomy method, a plastic tube is placed between two ribs by a doctor specialized in the field. The tube is then connected to a special device and the fluid is drained.

Video-assisted thoracic surgery: In this method, the specialist surgeon makes several small incisions and then, with the help of a special camera, removes the affected tissue around the lung and drains the fluid by placing a drainage tube or using medication.

Frequently Asked Questions

Although empyema is not very common, it is a health problem that requires diagnosis and treatment in the early period. Some of the frequently asked questions about empyema are discussed in detail below. Accumulation of fluid in the pleural cavity, i.e., pleural effusion, can occur for many reasons. Empyema is among the leading causes of pleural effusion. Pleural effusion, empyema, is the inflammation of the fluid accumulated in the pleural cavity due to a cause such as pneumonia. If fluid accumulation in the lung is not treated in the early period, it may cause serious complications, especially difficulty breathing. Treatment of pleural inflammation may vary depending on factors such as the patient's general health condition, the underlying cause of the inflammation and how early treatment was started. During the treatment process, the specialist doctor aims to bring the infection under control. In patients who start treatment early, the inflammation of the pleura may heal in a short time with drug therapy. However, in more severe infections, the duration of treatment may be longer. Fluid accumulation in the pleural cavity, also called water in the lung, can occur due to many causes. Lung diseases such as lung cancer, pulmonary embolism (blood clot), pneumonia and tuberculosis are among the main causes of fluid accumulation in the pleural cavity. In addition, health problems such as heart failure and liver and kidney diseases can also cause fluid accumulation in the pleural cavity. For this reason, during the treatment stage, specialists usually work together with other branches, especially oncology specialists, in a multidisciplinary approach. Do not neglect to apply to a healthcare facility and/or make an appointment with a doctor specialized in chest diseases and thoracic surgery and have your regular check-ups done.