Empyema thoracis: new insights into an old disease

Abstract

Pleural infection is a disease of historical importance and is still a modern menace, with incidences rising in adults and children, and a significant mortality in adults. Basic research is hampered by limitations with in vivo models, and the bacteriology of empyema is complex. The role of thoracic ultrasound in guiding investigation and drainage of empyema is clear. Prompt treatment with appropriate systemic antibiotics and chest tube drainage are the key; in cases of failure of these measures, thoracic surgery is of proven efficacy in the treatment of this age-old disease.

Figure 1.

Ultrasound image of multiple septations and loculations in a patient presenting with a pneumonic illness and pleural effusion. Courtesy of N. Rahman, Oxford University, UK.

Figure 2.

Contrast-enhanced computed tomography of the chest in a liver transplant patient on immunosuppression who developed pneumonia and complicated parapneumonic pleural effusion.

Figure 3.

Oesophageal pleural fistula in a patient with Crohn's disease. a) A small left empyema, b) treated with small-bore chest drain; subsequent cultures grew mixed Gram-negative bacteria and yeast. c) Subsequent barium swallow demonstrates leak of contrast into left pleural space (arrow).