Empyema (Pyothorax)

Week 1
Module 5
Dr. Kazzara Raeburn
Definition:
• A collection of pus (infective fluid) in the pleural cavity.
Pathophysiology:
• Exudative fluid with or without the presence of pus;
• Fibrinopurulent, when fibrous septa form localized pus pockets;
• Final organizing stage, when there is scarring of the pleura membranes with possible inability of the
lung to expand.
Epidemiology:
• It is usually associated with pneumonia (approximately 50%) but may also develop after thoracic
surgery or thoracic trauma.
Microbiology
• Most frequent organisms are:
• Pneumococcus (children)
• Penicillin-resistant Staphylococcus aureus
• Gram-negative bacteria
• Anaerobic bacteria: usually polymicrobial
• Staphylococcus aureus (post surgical)
Imaging:
Chest Radiographs:
• Often elliptical/lenticular in shape and loculated.
• Can often form an obtuse angle with the chest wall.
• May contain air.
• It does not move freely or layer on a decubitus x-ray.

CT Scan:
• Best way to further characterize and locate an empyema for possible drainage.
• Pleura is thickened due to fibrin deposition and in-growth of vessels with enhancement. At
the margins of the empyema, the pleura can be seen dividing into parietal and visceral
layers, the split pleura, which is the most sensitive and specific sign on CT.
 Markedly thickened pleura bilaterally with The left hemithorax is filled with a huge pleural collection with
calcified pleural plaques and resultant small air bubbles inside and with the left lung compressed
volume loss. medially and consequent mediastinal shift.
First Aid Radiology for the Wards – First Aid Series Case contributed to radiopedia.org by Dr David Cuete