Radiographic features Plain radiograph Can resemble a pleural effusion and can mimic a peripheral pulmonary abscess, although a number of features usually enable distinction between the two see empyema vs lung abscess 3. Pleural fluid is typically unilateral or markedly asymmetric 4. Generally, empyemas form an obtuse angle with the chest wall, and due to their lenticular shape are much larger in one projection e. Ultrasound The appearances of an empyema depend on the composition of the collection. Typically they are not uniformly anechoic and are often septated.
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These conditions can be fatal. If you have these symptoms, you should call or have someone drive you to an emergency room. Your doctor will take a complete medical history and physical examination. They may use a stethoscope to listen for any abnormal sounds in your lungs.
An ultrasound of the chest will show the amount of fluid and its exact location. Blood tests can help check your white blood cell count, look for the C-reactive protein, and identify the bacteria causing the infection. White cell count can be elevated when you have an infection. During a thoracentesis , a needle is inserted through the back of your ribcage into the pleural space to take a sample of fluid.
The fluid is then analyzed under a microscope to look for bacteria, protein, and other cells. Treatment is aimed at removing the pus and fluid from the pleura and treating the infection.
Antibiotics are used to treat the underlying infection. The specific type of antibiotic depends on what type of bacteria is causing the infection. The method used to drain the pus depends on the stage of the empyema.
In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneous thoracentesis. In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually performed under anesthesia in an operating room. There are different types of surgery for this: Thoracostomy : In this procedure, your doctor will insert a plastic tube into your chest between two ribs.
They may also inject medication to help drain the fluid. Video-assisted thoracic surgery: Your surgeon will remove the affected tissue around your lung and then insert a drainage tube or use medication to remove the fluid. They will create three small incisions and use a tiny camera called a thoracoscope for this process. Open decortication: In this surgery, your surgeon will peel away the pleural peel.
Outlook The outlook for empyema with prompt treatment is good. Long-term damage to the lungs is rare. You should finish your prescribed antibiotics and go in for a follow-up chest X-ray. Your doctor can make sure your pleura has healed properly. However, in people with other conditions that compromise the immune system, empyema can have a mortality rate as high as 40 percent.
What is empyema?
An X-ray can only identify empyema when there is a specific amount of fluid in the pleural cavity, however. If the doctor suspects there is liquid in the pleural cavity after a chest X-ray, they will carry out an ultrasound. Ultrasounds are more sensitive and better at detecting fluid in the pleural cavity. CT scans are also a useful method of detecting empyema. Treatment for empyema can include: Antibiotics Doctors usually prescribe antibiotics as the first treatment for simple cases of empyema. Because different strains of bacteria cause empyema, finding the right antibiotic is crucial.
Pleural empyema as seen on ultrasound  Pleural empyema as seen on ultrasound  Treatment[ edit ] Pleural fluid drainage[ edit ] Proven empyema as defined by the "golden" criteria mentioned earlier is an indication for prompt chest tube drainage. Because of the viscous, lumpy nature of infected pleural fluid, in combination with possible septation and loculation, it has been proposed that intrapleural fibrinolytic or mucolytic therapy might improve drainage and therefore might have a positive effect on the clinical outcome. Antibiotics[ edit ] There is no readily available evidence on the route of administration and duration of antibiotics in patients with pleural empyema. Experts agree that all patients should be hospitalized and treated with antibiotics intravenously. Anaerobic coverage must be included in all adults, and in children if aspiration is likely.