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Empyema is a condition in which pus and fluid from infected tissue collects in a body cavity. The name comes from the Greek word empyein meaning pus-producing (suppurate). Empyema is most often used to refer to collections of pus in the space around the lungs (pleural cavity), but sometimes refers to similar collections in the gall bladder or the pelvic cavity. Empyema in the pleural cavity is sometimes called empyema thoracis, or empyema of the chest, to distinguish it from empyema elsewhere in the body.


Empyema may have a number of causes but is most frequently a complication of pneumonia. Its development can be divided into three phases: an acute phase in which the body cavity fills with a thin fluid containing some pus; a second stage in which the fluid thickens and a fibrous, coagulation protein (fibrin) begins to accumulate within the cavity; and a third or chronic stage in which the lung or other organ is encased within a thick covering of fibrous material.

Causes and symptoms

Empyema thoracis can be caused by a number of different organisms, including bacteria, fungi, and amebas, in connection with pneumonia, chest wounds, chest surgery, lung abscesses, or a ruptured esophagus. The infective organism can get into the pleural cavity either through the bloodstream or other circulatory system, in secretions from lung tissue, or on the surfaces of surgical instruments or objects that cause open chest wounds. The most common organisms that cause empyema are the following bacteria: Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. S. aureus is the most common cause in all age groups, accounting for 90% of cases of empyema in infants and children. Pelvic empyema in women is most often caused by Bacteroides strains or Pseudomonas aeruginosa. In elderly, chronically ill, or alcoholic patients, empyema is often caused by Klebsiella pneumoniae species of bacteria.
When the disease organisms arrive in the cavity surrounding the lungs, they infect the tissues that cover the lungs and line the chest wall. As the body attempts to fight off the infection, the cavity fills up with tissue fluid, pus, and dead tissue cells. Empyema of the gall bladder or pelvis results from similar reactions to infection in those parts of the body.
The signs and symptoms of empyema vary somewhat according to the location of the infection and its severity. In empyema thoracis, patients usually exhibit symptoms of pneumonia, including fever, cough, fatigue, shortness of breath, and chest pain. They may prefer to lie on the side of the body affected by the empyema. Family members may notice bad breath. In severe cases, the patient may become dehydrated, cough up blood or greenish-brown sputum, run a fever as high as 105°F (40.6°C), or fall into a coma.
Patients with thoracic empyema may develop potentially life-threatening complications if the condition is not treated. The infected tissues may develop large collections of pus (abscesses) that can rupture into the patient's airway, or the infection may spread to the tissues surrounding the heart. In extreme cases the empyema may spread to the brain by means of bacteria carried in the bloodstream.
In pelvic empyema, the infection produces large amounts of thick, foul-smelling pus that is rapidly replaced even after drainage. Empyema of the gallbladder is marked by intense pain on the upper right side of the abdomen, high fever, and rigidity of the muscles over the infected area.


A physician may consider the possibility of empyema thoracis in patients with pneumonia or other symptoms of lung infection. When listening to sounds within the patient's chest with a stethoscope, the sounds of breathing will be partly muffled and harder to hear in the patients with empyema. The area of the chest over the infection will sound dull when tapped or thumped (percussed). On an x ray, empyema thoracis will appear as a cloudy or opaque area. The amount of fluid present in the pleural cavity can be estimated using an ultrasound imaging procedure. The diagnosis of empyema, however, has to be confirmed with laboratory tests because its symptoms can be caused by other disease conditions.
The diagnosis of empyema is usually confirmed by analyzing a sample of fluid taken from the pleural cavity. The sample is obtained by a procedure called thoracentesis. In this procedure, the patient is given a local anesthetic, a needle is inserted into the pleural cavity through the back between the ribs on the infected side, and a sample of fluid is withdrawn. If the patient has empyema, there will be a very high level of one particular kind of immune cell (white blood cells), a high level of protein, and a very low level of blood sugar. The fluid can also be tested for the specific disease organism by staining or tissue cultures. In some cases, the color, smell, or consistency of the tissue fluid also helps to confirm the diagnosis.


Empyema is treated using a combination of medications and surgical techniques. Treatment with medication involves intravenously administering a two-week course of antibiotics. It is important to give antibiotics as soon as possible to prevent first-stage empyema from progressing to its later stages. The antibiotics most commonly used are penicillin and vancomycin. Patients experiencing difficulty breathing are also given oxygen therapy.
Surgical treatment of empyema has two goals: drainage of the infected fluid and closing up of the space left in the pleural cavity. If the infection is still in its early stages, the fluid can be drained by thoracentesis. In second-stage empyema, the surgeon will insert a chest tube in the patient's rib cage or remove part of a rib (rib resection) in order to drain the fluid. In third-stage empyema, the surgeon may cut or peel away the thick fibrous layer coating the lung. This procedure is called decortication. When the fibrous covering is removed, the lung will expand to fill the space in the chest cavity. The doctor can use video-assisted thoracic surgery (VATS) techniques to position the chest tube or to perform a limited decortication. The VATS technique allows a physician to see within the body during certain surgical procedures. Empyema of the gallbladder is a serious condition that is treated with intravenous antibiotics and surgical removal of the gallbladder.


The prognosis for recovery is generally good, except in those cases with complications, such as a brain abscess or blood poisoning, or cases caused by certain types of streptococci.

Key terms

Abscess — An area of inflamed and injured body tissue that fills with pus.
Decortication — Surgical removal of the fibrous peel that covers the lungs in third-stage empyema.
Empyema — The collection of pus in a body cavity, particularly the lung or pleural cavity.
Fibrin — A fibrous blood protein vital to coagulation and blood clot formation.
Percussion — A diagnostic technique in which the back, chest, or abdomen is tapped to determine whether body cavities contain abnormal fluid.
Pleural cavity — The space surrounding the lungs, including the membranes covering the lungs and lining the inside of the chest wall.
Pneumonia — Inflammation of the lungs usually caused by a virus, bacteria, or other organism.
Resection — The surgical removal of part of an organ or body structure, as in rib resection.
Suppurate — To produce or discharge pus.
Thoracentesis — A procedure in which fluid is withdrawn from the pleural cavity through a needle inserted between the ribs. The fluid may be withdrawn either for diagnostic tests or to drain the cavity.
Video-assisted thoracic surgery (VATS) — A technique used to aid in the placement of chest tubes or when performing decortications when treating advanced empyema.



Stauffer, John L. "Lung." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


2. a pleural effusion containing pus; it occurs as an occasional complication of pleurisy or some other respiratory disease. Symptoms include dyspnea, coughing, chest pain on one side, malaise, and fever. thoracentesis may be done to confirm the diagnosis and determine the specific causative organism. Called also pyothorax and purulent or suppurative pleurisy (see pleurisy).
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


(em'pī-ē'mă, -pi-ē'mă),
Pus in a body cavity; when used without qualification, refers specifically to pyothorax.
[G. empyēma, suppuration, fr. en, in, + pyon, pus]
Farlex Partner Medical Dictionary © Farlex 2012


n. pl. empye·mata (-mə-tə)
The presence of pus in a body cavity, especially the pleural cavity.

em′py·e′mic adj.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Medtalk A collection of pus in a body cavity. See Pyothorax, Subdural empyemia.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


, pl. empyemata (em'pī-ē'mă, -tă)
Pus in a body cavity; when used without qualification, refers specifically to pyothorax.
[G. empyēma, suppuration, fr. en, in, + pyon, pus]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


A collection of pus in the space between the lungs and the chest wall (the pleural cavity). This usually results from PNEUMONIA, TUBERCULOSIS or cancer of the underlying lung. Empyema causes lung collapse and interferes with breathing and the pus must be removed. Also known as empyema thoracis. From Greek empuema , a gathering or suppuration.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005


, pl. empyemata (em'pī-ē'mă, -tă)
Pus in a body cavity.
[G. empyēma, suppuration, fr. en, in, + pyon, pus]
Medical Dictionary for the Dental Professions © Farlex 2012
References in periodicals archive ?
Literaturde empyema necessitatis hastalarinin yas araligi 3 ay-81 yas arasinda degismekle birlikte, ortalama yas 40'tir.
Subdural empyema and other suppurative complications of paranasal sinusitis.
They most frequently lead to clinical tables such as; pharyngitis, tonsillitis, red skin and soft tissue infections (impetigo, ecthyma, erysipelas), streptococcal toxic shock syndrome and rarely cause pneumonia, empyema, endocarditis, pericarditis, omphalitis, cellulitis and myositis.
Keywords: Empyema gallbladder, Efficacy, Laparoscopic cholecystectomy.
Chronic empyema can result in chondroid formation or in the more severe cases, complete filling of the pouch with purulent material.
[17] The remaining one (6.6%) infective complication in this series was empyema thoracis.
Prospective data available from both the Multicenter Intrapleural Sepsis Trial 1 (MIST1) and MIST2 trials showed no difference in efficacy of drainage of empyema between small-bore and large-bore drains.
On the other hand, we decided to maintain treatment for empyema until pleural infection was ruled out.
Jakovic et al., "Transthoracic ultrasonography in diagnosis and treatment of acute pleural empyema," Acta Chirurgica Iugoslavica, vol.
Postmus, "Pleural empyema caused by Clostridium perfringens," Respiratory Medicine, vol.