Pleural empyema - information and specialists

Pleural empyema is an accumulation of pus in the pleura between the pleura of the lungs and the pleura of the ribs. It is usually the result of pneumonia in which bacteria colonize the pleura. It is usually sufficient to take antibiotics and drain the pus.

Further information on pleural emp yema and which experts can help you with pleural empyema can be found in our article.

How common is pleural empyema?

Pleural empyema is a bacterial accumulation of pus in the pleura. Patients who are admitted to hospital withpleurisy often develop complications. Half of them develop pleural effusions. Pleural empyema develops in one in ten patients.

Patients with pleurisy have pain when breathing @ Maksym Povozniuk /AdobeStock

What are the causes of pleural empyema?

Pleural empyema is a serious complication of pleurisy and is often the result of bacterialpneumonia. Pleural empyema can also be caused by a lung abscess.

Other causes also trigger pleural empyema:

• A "blood poisoning" (sepsis)
• An injury (trauma) that causes the chest to open (= pneumothorax)
• If the esophagus is perforated. If a bacterial infection occurs as a result of these injuries, pus can accumulate in the pleura.

Which bacteria trigger pleural empyema?

It is often typical pyogenic pathogens and bacteria that trigger respiratory diseases:

• Streptococcus pneumoniae
• Staphylococcus aureus
• Pseudomonas aeruginas, a typical hospital germ and thus the trigger of so-called nosocomial infections
• Escherichia coli, an intestinal germ and
• Klebsiellen

What symptoms indicate pleural empyema?

The symptoms are usually non-specific, as most patients have previously suffered from severe pneumonia or pleurisy. Therefore, doctors often do not notice pleural empyema immediately.

Symptoms that occur are

• Fever
• night sweats
• cough
• Pain behind the breastbone
• Shortness of breath(dyspnoea)

How do doctors diagnose pleural empyema?

• Doctors' initial suspicions are usually based on the patient's medical history (anamnesis) and an abnormal chest X-ray.
• Doctors also use ultrasound and CT-supported imaging of the lungs to detect small amounts of effusion.
• However, the actual diagnosis is made by means of a pleural puncture.

Pleural puncture

During a pleural puncture, doctors use a thin needle to obtain some pleural secretions. Laboratory staff then examine the secretions for possible pathogens. Only then can doctors make a reliable diagnosis and therapy. The pleural puncture usually provides evidence of severe inflammation and the bacterial pathogens involved:

• There is a pH shift to acidic (pH < 7.1) due to inflammation.
• Lactate dehydrogenase (LDH) is a cellular enzyme that can be elevated in cases of severe inflammation (LDH > 1,000 U/l).
• The number of inflammatory cells, especially granulocytes, is increased.

As a rule, a bacterial pathogen is detected for pleural empyema.

During a pleural puncture, doctors remove fluid from the pleural cavity (space between the pleura and pleura) @ ellepigrafica /AdobeStock

How does pleural empyema progress?

Pleural empyema usually progresses in three stages:

1. Stage 1: There is a leakage of fluid into the pleural cavity (exudative phase)
2. Stage 2: A purulent-cloudy secretion develops (fibrinous-purulent phase)
3. Stage 3: The foci of inflammation heal slowly

Can pleural empyema be treated?

Once the diagnosis has been confirmed, pleural empyema is easily treatable. Antibiotics are usually sufficient to treat the bacterial infection.

However, it is important for doctors to have evidence of the pathogen in order to use the right antibiotic.

In recent years in particular, multi-resistant strains of pseudomonas germs, staphylococci and streptococci have emerged. These pose a challenge for doctors in terms of treatment.

Chest drainage helps to prevent the formation of secretions or exudate that make breathing difficult. This involves puncturing the patient's chest. This allows the secretions to drain to the outside. This procedure relieves the lungs and breathing.

If pleural empyema is resistant to treatment, doctors treat the patient with a thoracoscopy. During a thoracoscopy, doctors perform a surgical procedure to remove the pus. This procedure is usually performed using the "keyhole method", i.e. it is minimally invasive.

What is the prognosis for pleural empyema?

As with most acute diseases, early diagnosis and treatment is crucial for the prognosis. The sooner doctors recognize pleural empyema, the sooner they can start treatment.

Pleural empyema is often caused by pneumonia and usually shows no symptoms in young patients. This is why doctors often diagnose pleural empyema very late. The mortality rate is therefore quite high.

In the early stages, doctors treat the empyema with antibiotics and drainage. If the pleural empyema has been present for some time, surgical intervention is usually necessary.

Where is pleural empyema treated?

Pleural empyema is a disease that requires special tests and treatment. Hospitals that specialize in lung diseases and chest surgery are therefore ideal.

Specialists who treat pleural empyema are pulmonologists, thoracic surgeons and infectious disease specialists. They are supported by radiologists for diagnostic imaging and laboratory physicians for laboratory diagnostics.