Empyema, Causes, Diagnosis, Treatment, Prevention, Complications

Empyema is a buildup of pus in the pleural cavity, which is the area between the outer layer of the lung and the inner lining of the chest wall. This condition often occurs due to complications of infection in the lungs or pneumonia.

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Empyema, Causes, Diagnosis, Treatment, Prevention, Complications

Normally, the pleural cavity is filled with a small amount of fluid which functions as a lubricant so that the lungs move smoothly when breathing. When an infection occurs in the lungs, the pleural cavity can be filled with more fluid, then it becomes infected. As a result, there is a buildup of pus in the lining between the lungs and chest cavity.

Causes of Empyema

Empyema occurs due to infection that spreads from the lungs. It is this infection that causes pus to accumulate in the pleural cavity, then interferes with the function and work of the lungs.

Some conditions that can cause empyema are:

Pneumonia
Lung abscess
Chronic obstructive pulmonary disease (COPD)
Tuberculosis (TB)
Bronchiectasis
Serious injury to the chest, for example from a fall or accident
Infection in other parts of the body that spreads to the chest cavity through the bloodstream
Complications due to surgery on the chest, for example surgery to remove lung cancer or heart surgery

Empyema risk factors

Apart from the conditions above, there are several factors that can increase a person's risk of experiencing empyema, namely:

Has a weak immune system
Suffering from alcohol addiction
Have diabetes
Suffer from an autoimmune disease, such as rheumatoid arthritis
Suffering from acid reflux disease or GERD

Empyema Symptoms

Empyema symptoms appear depending on the type. In the early stages (simple empyema), symptoms that appear include:

Fever
shivers
Excessive sweating, especially at night
Chest pain that gets worse when you take a deep breath
Dry cough
Headache
The body gets tired easily
dazed
Loss of appetite
Short breath

Over time, the empyema will get worse and enter the final stage (complex empyema). At this stage, the inflammation in the lungs gets worse. Scar tissue may also form and divide the pleural space into smaller cavities. This condition, called loculation, can be increasingly difficult to treat.

If the infection continues to get worse, a thick lining will form around the pleural space. This layer makes it difficult for the lungs to expand, so they must be treated with surgery.

Some of the symptoms of complex empyema are:

It's hard to breathe
Chest pain that gets worse
Weakened breath sounds
Weight loss

When to see a doctor

Check with your doctor if you experience complaints as mentioned above. Immediately to the doctor if you feel increasingly difficult to breathe, shortness of breath, or chest pain that is getting worse.

If you suffer from an infectious disease, follow the recommendations and treatment given by the doctor. In addition, carry out regular controls according to the schedule given by the doctor and do not stop treatment carelessly.

Empyema Diagnostics

The doctor will ask questions and answers about the symptoms, as well as the patient's medical history and medication history. Doctors can suspect a patient has empyema if there is a history of untreated pneumonia.

The doctor will also examine the chest wall, one of which is by using a stethoscope, to listen for abnormal sounds in the patient's lungs.

To confirm the diagnosis, the doctor will carry out further tests, such as:

X-rays and CT scans of the chest, to detect the presence or absence of fluid in the pleural cavity
Chest ultrasound, to see how much pleural fluid is and the exact location of the fluid
Blood test, to measure the number of white blood cells and C-reactive protein (CRP) which increases when an infection occurs
Thoracocentesis or pleural puncture, to take a sample of pleural fluid which will then be examined to determine the cause of empyema

Empyema Treatment

Empyema treatment aims to treat infection and remove pus from the pleural space. Some of the treatment methods that can be done are:

Antibiotic infusion

Antibiotics are given to treat the infection. The type of antibiotic given will be adjusted to the type of bacteria causing the infection, one of which is a cephalosporin.

Thoracocentesis or pleural puncture

In addition to diagnosis, pleural puncture is used to remove fluid in the pleural space, especially in cases of simple empyema.

Operation

In the case of complex empyema, the doctor will perform a tube operation in the patient's chest to drain the pus. This procedure can be done in 3 ways, namely:

Thoracostomy

This procedure is performed by inserting a plastic tube into the patient's chest through a hole made between two ribs. The plastic tube is then connected to a suction device which will remove the fluid in the pleural space.

Video-assisted thoracic surgery (VATS)

This method aims to remove infected tissue in the lungs. The doctor will make three incisions and use a camera (thorascope) to insert a tube into the chest cavity. Pleural fluid will be removed through the tube.

Open decoration

Through open decortication, the doctor removes the layers of connective or fibrous tissue that cover the lungs and pleural space. This action aims to restore lung function so that it can inflate and deflate normally.

Empyema complications

Although rare, complex empyema can lead to dangerous complications, such as:

Sepsis, namely the spread of infection throughout the body's tissues
Collapsed lung (pneumothorax), namely deflation of part or all of the lung due to accumulation of air in the pleural cavity
Thickening of the pleural lining due to the formation of connective tissue or fibrosis
Decreased lung function

Empyema Prevention

The best way to prevent empyema is to avoid factors that can cause infection in the lungs. Some ways that can be done are:

Maintain cleanliness, such as washing hands regularly with water and soap or hand sanitizer
Check with your doctor if you are sick and follow the therapy given by the doctor to completion
Quit smoking and avoid exposure to cigarette smoke and air pollution
Increase endurance, one of which is by exercising regularly
Vaccination according to age and schedule, including flu vaccine and pneumonia vaccine

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