Abstract
Pleural emyema often develops either due to secondary spread from contagious structures (lung, oesophagus, sub-phrenic collections) or from pleural space inoculation. Clinical presentation is generally with cough, dyspnoea, chest pain and pyrexia. Clinical features and chest radiology (plain films/CT) may suggest the diagnosis; aspiration of purulent pleural fluid confirms this. Bacteriology reflects the aetiology in most cases; it is polymicrobial in 40&. Negative cultures may reflect prior antibiotic therapy. Progressive development of the empyema is accompanied by progressive localisation and fibrosis, through stages I to III. Management requires both appropriate antibiotics together with adequate pleural drainage. The latter may be achieved by intercostal drainage alone for early stages. Later stages may require surgical drainage (thoracoscopy or thoracotomy). Significant fibrosis may result in a ‘trapped’ lung requiring surgical decortication achieving both complete pleural drainage and pulmonary expansion are the essential treatment aims.
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