Empyema is the development of pus in the pleural cavity, or the space between the lung and chest wall, that usually develops from infection in the lung or pneumonia. Patients with empyema exhibit symptoms that may include fever, chills, cough, shortness of breath and chest pain.

The diagnosis is made with chest X-ray and CT of chest that shows the extent of the empyema along with a thoracentesis to confirm the diagnosis.

  1. CT of chest—This study is performed in radiology. It is performed to determine if there is any mass that is causing compression of the phrenic nerve.
  2. Thoracentesis—This study is either performed in radiology or at the patient’s bed. An ultrasound is placed on the chest to locate the pleural fluid. Under ultrasounds, a needle is placed in the chest cavity and fluid is removed for analysis.

The goal of the treatment for empyema is to remove the infected fluid. Initially, we place a chest tube to remove the fluid. If the empyema does not resolve, we place tPA or tissue plasminogen activator through the chest tube to help break the loculation.

In our practice, we treat patients with persistent empyema despite using a chest tube with VATS lung decortication to completely remove the infected fluid and pleural rind.