Purpose of review Empyema
is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although a majority of them are post-bacterial pneumonia caused by tuberculosis or by infection following penetrating chest injuries or surgical procedures. It is still associated with significant morbidity and mortality in adults and children despite optimal management according to current guidelines. Historically, empyema
management has been empirical, but more recent data are leading to more focused management guidelines.
The number of therapeutic agents licensed for intrapleural use or undergoing clinical trials in the management of empyema
continues to expand, although their use is currently controversial and probably best limited to trials and specialist centers. Although their use is limited by availability, ultrasound and guided aspiration is the investigation of choice in suspected empyema
. It is safer, more sensitive, provides more information, and, in the case of guided-drainage
, is more likely to be effective. Finally, there is a growing body of literature that supports very early involvement of thoracic surgeons in empyema
management. An emerging question for the future is whether some or indeed all patients with empyema
should now bypass medical thoracostomy and proceed directly to video-assisted thoracoscopic surgery
for both acute and chronic empyemas.
A summary of the most recent opinions and results in thoracic empyema
management is outlined. Treatment of empyema
can be summarized as appropriate antibiotic therapy combined with medical or surgical pleural space drainage
, management of any underlying factors, with further surgery indicated for chronic disease.