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Empyema (pus or pus) in lungs, often due to pneumonia

With an empyema, pus (pus) collects in the space between the lungs and the inside of the chest wall (pleural space or chest cavity). Pus contains bacteria, cells that cause inflammation, damaged tissue and clotted blood products. An empyema is often the result of pneumonia, but other causes also result in an empyema. Fever, a dry cough and a feeling of illness are some symptoms of empyema. The treatment consists of draining the fluid in combination with medication. The condition is uncommon because most patients receive effective treatment with antibiotics, which prevents symptoms from developing. The prospects are good with prompt diagnosis and treatment.

  • Synonyms empyema
  • Causes: Often due to pneumonia
  • Risk factors pus or pus in the lungs
  • Symptoms: Shortness of breath, feeling sick
  • Diagnosis and examinations
  • Treatment: Drain pus
  • Prognosis
  • Complications


Synonyms empyema

An empyema in the lungs is also known by these synonyms:

  • Empyema
  • Purulent pleurisy (pleurisy with chest pain)
  • Pleural empyema
  • Pyothorax


Causes: Often due to pneumonia

An empyema is usually due to an infection that has spread to the lungs. This leads to an accumulation of pus in the pleural space. This pus puts pressure on the lungs. Very often, an empyema is the result of (poor treatment of) pneumonia (= pneumonia: inflammation of the lower respiratory tract).

Risk factors pus or pus in the lungs

Risk factors for an empyema in the lungs include the following conditions:

  • alcoholism
  • bronchiectasis (dilated and irritated airways)
  • chronic obstructive pulmonary disease (COPD)
  • diabetes mellitus
  • a (bacterial) pneumonia
  • chest surgery
  • a lung abscess
  • trauma or injury to the chest
  • a weakened immune system
  • gastroesophageal reflux (heartburn due to stomach contents flowing back into the esophagus)
  • rheumatoid arthritis (chronic autoimmune disease involving inflammation of joints and other organs)
  • tuberculosis

In rare cases, an empyema occurs after a thoracocensis . This is a treatment in which the doctor inserts a needle through the chest wall to drain fluid from the pleural space, which is useful for medical diagnosis or treatment. Patients who do not complete antibiotic treatment for pneumonia are also at higher risk of developing empyema.Chest pain occurs with pus or pus in the lungs / Source: Pexels, Pixabay

Symptoms: Shortness of breath, feeling sick

Lung-related symptoms due to the pus or pus in the lungs include a dry and persistent cough that does not respond to antibiotics, shortness of breath (dyspnea), reduced mobility on one side of the chest while breathing, and chest pain that worsens with deep breathing ( stabbing pain). General symptoms of empyema include a generally ill feeling (malaise), headache, fever and chills, unintentional weight loss, excessive sweating (hyperhidrosis) (especially night sweats), and confusion.

Diagnosis and examinations

Physical examination

The doctor listens to the breathing sounds with a stethoscope (auscultation). He hears an abnormal rubbing sound.

Diagnostic research

The following diagnostic tests are necessary to confirm the diagnosis of empyema in the lungs:

  • An analysis of the pleural fluid shows the presence of a yellow-green pus.
  • A CT scan of the chest cavity
  • An ultrasound of the chest cavity: this examination reveals the amount of fluid in the chest.
  • A thoracentesis (a puncture of the chest which is also useful to remove excess draft)
  • A chest x-ray (X-ray of the chest): the fluid is colored white, especially in the lower part of the lung.


Differential diagnosis

The doctor may sometimes miss an empyema or confuse it with another condition that has a similar set of symptoms. This may be the case with the following conditions:

  • aspiration pneumonia (pneumonia due to inhaling foreign substances)
  • bronchiolitis obliterans (lung disease with dry cough)
  • a bacterial pneumonia
  • a pleural effusion (fluid accumulation between the pleura and the lining of the lungs))
  • a pulmonary embolism (blockage of an artery in the lungs)
  • a pneumonia
  • granulomatosis with polyangiitis (Wegener’s granulomatosis) (autoimmune disorder)
  • Langerhans cell histiocytosis (multisystem disorder)
  • sarcoidosis (disease of the skin, lungs, eyes and nervous system)
  • tuberculosis (bacterial infection with lung problems)


Treatment: Drain pus

The doctor wants to cure the infection and remove the pus from the body. When the pus has been drained from the body, the patient recovers better. That is why he places a plastic tube in the chest from which the pus drains (= drain). This is known in medical terms as a chest tube. In rare cases, this requires surgery. The patient also receives antibiotics to combat the infection. In case of breathing problems, the doctor performs surgery to expand the lungs sufficiently.


In general, most patients recover completely from empyema. However, when empyema is a complication of pneumonia, the risk of permanent lung damage and death increases. Long-term treatment with antibiotics and drainage is then necessary.


An empyema in the lungs may lead to a thickening of the pleura (pleura: the membrane that lines the inside of the chest and the outside of the lungs) and/or reduced lung function, resulting in breathing problems. In rare cases, the patient develops sepsis (blood poisoning: exaggerated response of the immune system to germs) or a pneumothorax (collapsed lung).

read more

  • Pneumonia: Inflammation of the lower respiratory tract

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