Empyema Definition
Empyema is an accumulation of pus between the lung and the membrane that covers it (pleural space) that can occur when a lung becomes infected.
Symptoms of Empyema
The initial symptoms, especially in thoracic empyema, are bacterial pneumonia. Patients who are treated inadequately or with inappropriate antibiotics may have an interval of several days between the clinical pneumonia phase and evidence of empyema. Most patients have fever, tachycardia, shortness of breath, cyanosis, and cough, and physical examination will reveal signs such as pleural effusion.
Causes of Empyema
More than 50 percent of empyema causes are parapneumonic effusions, while 25 percent occur after lung, esophageal, or mediastinal surgery. 10 percent occur due to thoracic trauma, and 15 percent occur due to sepsis, tuberculosis, necrotizing enterocolitis, subdiaphragmatic abscess, or spontaneous pneumothorax.
Empyema can be caused by bacteria, fungi, or amoeba. These organisms can reach the pleural cavity through blood circulation, lung tissue, or the surface of organs that cause chest wounds, such as chest wounds after surgery, esophageal rupture, and others. Fifty percent of empyema is caused by monomicrobial, and the remaining 50 percent is polymicrobacterial.
Risk Factors for Empyema
Risk factors for empyema include poor dental hygiene, seizure disorders, and alcohol and drug use. Other sufferers at risk for pulmonary empyema include:
- Individuals with decreased immune systems, such as those undergoing steroid chemotherapy, malnutrition, and multiple trauma.
- Individuals with decreased consciousness, coma, general anesthesia, and sedation.
- Patients with primary lung disorders.
Diagnosis of Empyema
The diagnosis of empyema can be obtained through the following:
- From the anamnesis examination, fever and night sweats, pleural pain, shortness of breath, and weight loss were found.
- Supporting examinations that are usually performed include chest X-ray, culture and sensitivity tests of aspirated drainage from the pleura, and CT scans that are used to differentiate parenchymal abnormalities from the pleura, evaluate parenchymal abnormalities, determine loculation, evaluate the pleural surface, and help determine the therapy that needs to be performed.
- Physical examination and supporting examinations are very important in cases of empyema so that the therapy and actions given can be appropriate to the condition experienced, so that complications that arise can be avoided.
Empyema Treatment
Treatment includes administering appropriate medication according to the patient’s condition, physiotherapy with postural drainage, and surgery is performed in cases that do not respond to intensive, long-term treatment or with complications of coughing up blood, and empyema or malignancy. In addition, side effects or complications of empyema can cause fistulas in the bronchopleura, shock, sepsis, and congestive heart failure.
In empyema as a complication of pneumonia or bronchopneumonia, there is an interval period. In older children, pneumonia treatment only eliminates clinical symptoms and does not kill other causative germs, and a latent period of several weeks occurs.
Prevention of Empyema
Empyema is often preceded by a lung infection or pneumonia. Therefore, empyema can be prevented by early detection and treatment of pneumonia sufferers. If pneumonia is treated, it is expected that it will not reach the empyema stage.
When to See a Doctor?
Contact a doctor immediately if you experience the above symptoms. Proper handling can minimize the consequences, so that treatment can be done more quickly.
