Symptoms and consequences

In addition to general symptoms caused by an underlying infection such as fatigue, fever, etc. pain, swelling, redness, warming and functional impairment are also possible due to the local inflammatory reaction. However, the severity of these symptoms depends on the location and extent of the empyema.

Since the purulent interior of an empyema is not easily accessible for both immune cells (leukocytes) and drugs, an empyema can sometimes persist for a long time without medical intervention. The pus can also serve as a food source for other germs. Furthermore, every empyema carries the danger that germs from the pus accumulation can enter the bloodstream and settle elsewhere (scatter) or trigger the clinical picture of life-threatening blood poisoning (sepsis). Finally, in the course of the healing of a (purulent) inflammation, adhesions can occur, which can subsequently cause problems, especially in the abdominal cavity and in the gap between the lung and the chest wall.

Diagnosis

Sometimes, a conscientious medical examination (anamnesis) and physical examination can lead to an urgent suspicion of an empyema and its location. A laboratory examination of the blood can also be continued by an existing increase of so-called inflammation parameters. The best way to localize an empyema, however, is to use imaging techniques such as ultrasound (sonography), MRT or CT.

The presence and location of an empyema can also be determined with certainty during surgery. The inside of a pus accumulation is generally difficult for immune cells and drugs (such as antibiotics, which are useful here) to reach. From a certain size of an empyema, therefore, in addition to systemic therapy with an antibiotic therapy adapted to the pathogen (and its resistance) (in tablet form or via an indwelling cannula), a surgical opening of the cavity to drain the pus should be considered.In some cases, it may also be useful not only to rinse the body cavity with disinfectant solutions during the operation, but even to insert antibiotic solution or temporarily a chain, sponge or the like.

If there is an accumulation of pus in the gap between the lung and the chest wall (pleural gap) or in the abdominal cavity, where there is a risk of adhesions, it can be rinsed with a special solution to prevent this. The procedure is then usually concluded with the insertion of a drainage, which can also be used to drain off secretions and thus prevent the immediate formation of new empyema. This drainage then remains in place for hours or days; in extreme cases, it may even require multiple replacements. Depending on the case and location, the procedure is performed either under local anesthesia or in the operating room.