Empyema is a condition when a collection of pus forms in the pleural space, which is the area between the lungs and the inner surface of the chest wall. Empyema usually occurs after a person has an infection of the lung tissue (pneumonia).
Symptoms of Empyema
Empyema is divided into 2 types with different symptoms. The first type is simple empyema. This type of empyema appears in the early stages of the disease. A person can be said to have a simple empyema if the pus flows freely. Simple empyema symptoms include:
- Short breath.
- Dry cough.
- Fever.
- Sweating.
- Pain in the chest when breathing.
- Headache.
- Disorientation.
- Loss of appetite.
The second type of empyema is a complex empyema that appears in the later stages of the disease. In complex empyema, the inflammation becomes more severe. Scar tissue may form and divide the pleural space into small cavities. This condition is called loculation and will be more difficult to treat. If the infection gets worse, it will lead to the formation of a thick layer around the pleural space. This layer makes it difficult for the lungs to expand. Symptoms of complex empyema include:
- It's hard to breathe.
- Pain in the chest.
- Losing weight.
- Breath sounds decrease.
Causes of Empyema
Normally, the pleural space is filled with fluid, but not much. When an infection occurs, the production of fluid in the pleural space will be more, so that the absorption of fluid by the body cannot compensate. The infected pleural fluid thickens, forms pus, and can cause the lining of the lungs to stick together and form pockets. This pocket of pus is called an empyema.
Empyema can occur as a complication of the following conditions:
- Pneumonia is the most common cause of empyema.
- Bronchiectasis.
- Lung abscess.
- Chronic obstructive pulmonary disease (COPD).
- Serious injury to the chest.
- Infection in other parts of the body and spreads to the chest cavity through the bloodstream.
- Undergo surgery on the chest.
In addition, having the following conditions increases the chance of developing an empyema:
- Rheumatoid arthritis.
- Diabetes.
- Weak immune system.
- Alcohol addiction.
Empyema diagnosis
Your doctor may suspect that you have empyema if treatment for pneumonia doesn't work. As a first step in diagnosis, the doctor will usually take a history of complaints and previous illnesses, and perform a physical examination using a stethoscope to listen for abnormal sounds in your lungs. Then, the doctor will perform further tests to confirm the diagnosis. Among others are:
- X-rays and CT scans. Both of these examination methods will be performed on the chest to show the presence or absence of fluid in the pleural space.
- chest ultrasound, to find out the actual amount of fluid and its location.
- Blood test. This test is done to determine the white blood cell count and C-reactive protein (CRP). Elevated white blood cells and CRP may occur during infection.
- Thoracocentesis. During the procedure thoracocentesis (pleural puncture), a needle is inserted through the back of the chest between the ribs into the pleural space to collect a sample of fluid. The fluid is then analyzed and looked for the cause.
Empyema Treatment
Empyema treatment aims to treat the infection and remove pus from the pleural space. Some types of treatment that can be done, among others are:
- Antibiotics. Treatment of infection is done by using antibiotics that are tailored to the type of bacteria causing the infection.
- Percutaneous thoracocentesis. Apart from diagnosis, thoracocentesis or this pleural puncture can aim to remove fluid in the pleural space. This procedure is usually performed in cases of simple empyema.
- Operation. In the case of complex empyema, a rubber tube will be inserted to drain the pus. This procedure is usually done through surgery. There are several types of operations, namely:
- Thoracostomy. In this surgical procedure, the doctor will insert a plastic tube into the chest through the hole made between the two ribs. Then, the doctor will connect the plastic tube to the suction device to drain the fluid. The doctor will also inject drugs to help drain the fluid.
- Video-assisted thoracic surgery (VATS). The surgeon will remove the infected tissue around the lung, then insert a tube and use drugs to drain fluid from the pleural space. The doctor will make three incisions and use a small camera called thoracoscope in this process.
- Open decoration. This surgical procedure is performed by removing the fibrous layer (fibrous tissue) that covers the lungs and pleural space. This action is done to restore lung function so that it can expand and deflate back to normal.
Complications of Empyema
Although very rare, complex empyema can lead to increasingly dangerous complications. Among others are:
- Sepsis. This condition occurs due to the immune system working continuously to fight infection. During this process, large amounts of chemicals are released into the blood, triggering widespread inflammation and can cause organ damage. Symptoms of sepsis include high fever, chills, rapid breathing, fast heart rate, and low blood pressure.
- Lung collapse (pneumothorax). A collapsed lung can cause sudden chest pain and shortness of breath. This condition will get worse when coughing or breathing. If you don't get treatment right away, the consequences will be fatal.
