pleuraempyema

Pleural empyema is the collection of purulent fluid within the pleural space, the thin serous membrane that lines the lungs and wraps around the chest wall. It usually results from an infection that breaches the pleural membrane, commonly following bacterial pneumonia, thoracic surgery, chest trauma, or invasive medical procedures. The condition is distinguished from a simple parapneumonic effusion by the presence of frank pus, low pH, and high lactate dehydrogenase levels in the pleural fluid.

Symptoms typically include chest pain that worsens with breathing, a productive cough, fever, and shortness of breath. Severity can range from mild discomfort in early stages to respiratory distress and sepsis in advanced disease. Physical examination may reveal dullness to percussion, decreased breath sounds, and sometimes a pleural rub.

Diagnostic confirmation relies on imaging and fluid analysis. Chest radiography can show a loculated fluid collection; computed tomography gives more detail. Thoracentesis with pleural fluid analysis and culture is essential; diagnostic criteria include a fluid pH below 7.2, glucose below 60 mg/dL, or a lactate dehydrogenase level exceeding 1000 IU/L.

Treatment involves antibiotic therapy tailored to the likely organisms, often gram‑positive cocci and gram‑negative bacilli. The first line of management is pleural drainage, either via repeated percutaneous chest tube placement or surgical decortication if the empyema has organized into thick strands. In selected cases, intrapleural fibrinolytic agents such as tissue plasminogen activator can facilitate drainage. Early intervention improves outcomes, reduces the length of hospital stay, and lowers the risk of long‑term pulmonary dysfunction.