Empyema
Classification and external resources
ICD-10	510.9
MeSH	D004653

An empyema is a collection of pus within a naturally existing anatomical cavity, such as the lung pleura. It must be differentiated from an abscess, which is a collection of pus in a newly formed cavity.

Usually an empyema starts with pneumonia, followed by a parapneumonic effusion. This effusion, which starts out sterile, then becomes infected. As the infection progresses, the thickness of the fluid increases, going from a broth type consistency to concrete. When the fluid is still free flowing, it can be treated with a thoracentesis or a chest tube. When it thickens, it can usually be treated with thoracoscopy (Video Assisted Thoracic Surgery; VATS). Once the fluid becomes thick and loculated, a formal thoracic surgical procedure called a thoracotomy with decortication is required. This involves opening the chest, taking out the fluid, peeling the thick rind of infectious material off the lung, and then inserting chest tubes while the infection clears (usually with the help of antibiotics). Chest tubes in the setting of empyema have a tendency to become clogged. Chest tube clogging in the setting of an empyema can lead to re-accumulation of pus and infected material, a worsening clinical picture, organ failure and even death. Thus managing chest tube clogging is particularly important after the treatment of an empyema.

In human medicine, empyema occurs in:

• the pleural cavity (pleural empyema)
• the uterus (pyometra)
• the appendix (appendicitis)
• the meninges (subdural empyema)
• the joints (septic arthritis)
• the gallbladder
• the brain (subdural empyema)

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