Emergent management of empyema

Abstract

Empyema is a frankly purulent infection of the pleural space most often occurring secondary to parapneumonic effusion. Imaging, specifically contrast-enhanced computed tomography, plays a critical role in diagnosis with a "split pleurao" sign being highly suggestive in the appropriate clinical setting. Diagnostic thoracentesis with culture and Gram stain further guides appropriate antibiotic therapy. Therapeutic drainage with small-bore tube thoracostomy has been shown to be a safe and effective treatment of early stage empyema. Augmentation of tube placement with intrapleural fibrinolytics and mucolytics facilitates catheter drainage by degrading loculations and decreasing fluid viscosity, respectively. Copyright © 2012 by Thieme Medical Publishers, Inc.