Pulmonary Empyema

What is Pulmonary empyema?

Pulmonary empyema is a buildup of pus in the pleural space (space between the lung and chest wall).  It is a complication of bacterial pneumonia when the bacteria get into the pleural space and infect the tissue that lines the inside of the chest. Pulmonary empyema:

• occurs infrequently and can happen to anyone
• requires hospitalization for effective treatment

What are the signs and symptoms?

Symptoms of bacterial pneumonia include:

• Fever
• Weak cough
• No interest in activity
• Poor appetite

If empyema develops, symptoms become worse, and your child may have the following:

• Very tired
• Fever over 102°F
• Shallow and rapid breathing

Sometimes the pus pushes on the healthy lung and it becomes hard to breathe. This can cause:

• Shortness of breath with gasping
• Pale or grey color
• Difficulty walking
• Chest pain with anxiety

How is pulmonary empyema diagnosed?

Tests to diagnose pulmonary empyema include:

• Chest x-ray to confirm that an empyema is present and estimate the amount of pus in the chest
• Ultrasound of the chest to determine the thickness and amount of pus
• A computed tomography study (CT scan) may be done if there is any question about the diagnosis, but is usually not necessary
• Blood tests to check for changes due to the empyema
• A culture of the pus from the chest is the best way to identify the bacteria causing empyema

How is it treated?

• Pain medicine is used to keep your child comfortable
• Antibiotics are given for 14 days or more depending on the bacteria causing the infection
• A chest tube (a small tube inserted between the ribs through the chest wall) is placed to drain the pus from the inside of the chest (see education sheet “Chest tube”)
• The chest tube stays in place for 3 to 5 days
• Oftentimes, medicine is given through the chest tube to help dissolve and drain the thick pus

In 10-20% of patients, surgery may be needed to help drain the pus. This surgery is called a VATs procedure (Video-Assisted Thoracoscopic surgery).  Several small incisions are made in the chest wall: one for a small video camera and others for instruments.  Pus and blood are removed from the chest. After the procedure the child returns to the hospital room with a chest tube in place to collect any remaining pus. This chest tube stays in place for 3 to 5 days. Pain medications are given to keep your child comfortable.

What else do I need to know?

• Your child will be eligible for discharge after the chest tube is removed and he or she is able to drink fluids and take oral medications.
• Children can easily lose 1 – 5 pounds during a complicated infection and nutrition is important to help with wound healing.
• Remember, the lung is temporarily injured during pneumonia, but will heal with antibiotics and nutrition.
• Pulmonary empyema is an uncommon complication of pneumonia and rarely recurs.
• Children who experience pulmonary empyema are not vulnerable to subsequent lung infections.
• Lung function studies performed months or years after pulmonary empyema reveal that children have remarkable healing ability.
• Pulmonary empyema generally does not limit a child’s ability to participate in normal activity within one month of the event.
• Additional antibiotics for 1 or more weeks may be required.

Questions?

This information is not specific to your child, but provides general information. If you have any questions, call your clinic.

Reviewed by Kuracheck 2/2017

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