Empyema

Empyemas are purulent inflammatory collections within a body cavity. Contrast this with abscesses, which arise within parenchymal tissue, rather than occupying a pre-existing anatomical space.

Colloquially, the standalone term empyema is used to refer to thoracic empyemas but there are various different types of empyema which are described by the organ affected:

Empyemas are predominantly caused by bacterial infection of fluid within a pre-existing anatomical space. Once significant bacterial translocation has occurred there is significant deposition of fibrin and a reactive inflammatory response which results in the accumulation of pyogenic and fibrous material within the cavity.

The pathogenesis of an empyema usually requires a small stagnant fluid collection which in the case of the gallbladder requires a degree of biliary tract obstruction. 

Like abscesses, as the vascular supply to an empyema is poor, antimicrobial treatment on its own is usually insufficient to treat the underlying infection and drainage of the collection is usually required. This is often done percutaneously with ultrasound guidance although open surgical drainage can be necessary in complex cases. 

In cases of empyema involving synovial joints surgical washout can often be the preferred treatment method since the preservation of joint surfaces from damage from infection or the post-infectious inflammatory process is important to preserve function.

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Article information

rID: 39590
Section: Gamuts
Tag: refs
Synonyms or Alternate Spellings:
  • Empyemas
  • Empyema: general

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Cases and figures

  • Case 1: subdural empyema
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  • Case 2: thoracic empyema
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  • Case 3: gallbladder empyema
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  • Case 4: thoracic empyema
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  • Case 5: subdural empyema
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  • Case 6: SIJ empyema
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