Empyema is a buildup of pus in the pleural cavity, which is the area between the outer layer of the lung and the inner lining of the chest wall. This condition often occurs due to complications of infection in the lungs or pneumonia.

Normally, the pleural cavity is filled with a small amount of fluid that acts as a lubricant to allow smooth movement of the lungs when breathing. When there is an infection in the lungs, the pleural cavity can fill with more fluid, which then becomes infected. As a result, there is a buildup of pus in the lining between the lungs and the chest cavity.

Causes of Empyema

Empyema occurs due to infection that spreads from the lungs. It is this infection that causes pus to accumulate in the pleural cavity, then interferes with the function and work of the lungs.

Some conditions that can cause empyema are:

  • Pneumonia
  • Lung abscess
  • Chronic obstructive pulmonary disease (COPD)
  • Tuberculosis (TB)
  • Bronchiectasis
  • Serious injury to the chest, for example from a fall or accident
  • Infection in other parts of the body that spreads to the chest cavity through the bloodstream
  • Complications due to surgery on the chest, for example surgery to remove lung cancer or heart surgery

Empyema risk factors

In addition to the above conditions, there are several factors that can increase a person's risk of developing empyema, namely:

  • Have a weak immune system
  • Suffering from alcohol addiction
  • Suffering from diabetes
  • Suffering from an autoimmune disease, such as rheumatoid arthritis
  • Suffering from stomach acid disease or GERD

Symptoms of Empyema

Empyema symptoms appear depending on the type. In the early stages ( simple empyema ), symptoms that appear include:

  • Fever
  • shivers
  • Excessive sweating, especially at night
  • Chest pain that gets worse when you take a deep breath
  • Dry cough
  • Headache
  • Body tired easily
  • dazed
  • Loss of appetite
  • Short breath

Over time, empyema will worsen and enter the final stage ( complex empyema ). At this stage, the inflammation in the lungs gets worse. Scar tissue can also form and divide the pleural space into smaller cavities. This condition, called loculation , will be more difficult to treat.

If the infection continues to get worse, a thick lining will form around the pleural space. This layer makes it difficult for the lungs to expand, so they must be treated with surgery.

Some of the symptoms of complex empyema are:

  • It's hard to breathe
  • Chest pain that gets worse
  • Weakened breath sounds
  • Weight loss

When to see a doctor

Check with your doctor if you experience complaints as mentioned above. Immediately to the doctor if you feel increasingly difficult to breathe, shortness of breath, or chest pain that is getting worse.

If you suffer from an infectious disease, follow the recommendations and treatment given by the doctor. In addition, carry out regular controls according to the schedule given by the doctor and do not stop treatment carelessly.

Empyema diagnosis

The doctor will ask questions and answers about the symptoms, as well as the patient's medical history and medication history. Doctors can suspect a patient has empyema if there is a history of untreated pneumonia.

The doctor will also examine the chest wall , one of which is by using a stethoscope, to listen to abnormal sounds in the patient's lungs.

To confirm the diagnosis, the doctor will carry out further tests, such as:

  • X -rays and CT scans of the chest, to detect the presence or absence of fluid in the pleural cavity
  • Chest ultrasound , to see how much pleural fluid is and where it is located
  • Blood test , to measure the number of white blood cells and C-reactive protein (CRP) that increases during an infection
  • Thoracocentesis or pleural puncture, to take a sample of pleural fluid which will then be examined to determine the cause of empyema

Empyema Treatment

Empyema treatment aims to treat infection and remove pus from the pleural space. Some of the treatment methods that can be done are:

Antibiotic infusion

Antibiotics are given to treat the infection. The type of antibiotic given will be adjusted to the type of bacteria causing the infection, one of which is a cephalosporin .

Thoracocentesis or pleural puncture

In addition to diagnosis, pleural puncture is used to remove fluid in the pleural space, especially in cases of simple empyema .


In the case of complex empyema , the doctor will perform surgery to insert a tube in the patient's chest to drain the pus. This procedure can be done in 3 ways, namely:

  • Thoracostomy
    This procedure is performed by inserting a plastic tube into the patient's chest through a hole made between two ribs. The plastic tube is then connected to a suction device which will remove the fluid in the pleural space.
  • Video-assisted thoracic surgery (VATS)
    This method aims to remove infected tissue in the lungs. The doctor will make three incisions and use a camera ( thorascope ) to insert a tube into the chest cavity. Pleural fluid will be removed through the tube.
  • Open
    decortication Through open decortication, the doctor will remove the layer of connective or fibrous tissue that covers the lungs and pleural space. This action aims to restore lung function so that it can expand and deflate normally.

Empyema complications

Although rare, complex empyema can lead to dangerous complications, such as:

  • Sepsis , which is the spread of infection throughout the body's tissues
  • Lung collapse ( pneumothorax ), namely deflation of part or all of the lung due to accumulation of air in the pleural cavity
  • Thickening of the pleural lining due to the formation of connective tissue or fibrosis
  • Decreased lung function

Empyema Prevention

The best way to prevent empyema is to avoid factors that can cause infection in the lungs. Some ways that can be done are:

  • Maintain cleanliness, such as regularly washing hands with water and soap or hand sanitizer
  • Check with the doctor if you are sick and follow the therapy given by the doctor to completion
  • Quit smoking and avoid exposure to cigarette smoke and air pollution
  • Increase endurance, one of which is by exercising regularly
  • Vaccination according to age and schedule, including flu vaccine and pneumonia vaccine
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