Empyema awareness

Overview

Empyema is a serious condition where pus (a thick, yellow or green fluid made of dead cells and bacteria) collects in the space between your lung and the chest wall. This space is called the pleural space. It usually happens as a complication of pneumonia (a lung infection).

Empyema is not very common, but it can occur after pneumonia, especially if the pneumonia is severe or not treated quickly. It is more common in people with weakened immune systems or other lung problems.

Anyone can get empyema, but it happens more often in people with pneumonia, diabetes, chronic lung diseases (like COPD), a weakened immune system, or those who have had chest surgery or injury.

Symptoms

Common symptoms

• High fever and chills
• Chest pain that gets worse when you cough or breathe deeply
• Cough (often with yellow or green phlegm)
• Shortness of breath
• Feeling very tired and unwell

Symptoms in children

• Fever and irritability
• Fast or difficult breathing
• Cough
• Poor feeding or not wanting to eat
• Being unusually sleepy or fussy

Symptoms in older adults

• Confusion or feeling confused
• Rapid breathing or feeling breathless
• Fever (may be lower than in younger people)
• Weakness and loss of appetite
• Chest pain that may be less obvious

Causes

Main causes

• Bacterial pneumonia that spreads to the pleural space
• Lung infection after chest surgery or injury
• Spread of infection from other parts of the body through the bloodstream

Risk factors

• Having pneumonia, especially if not treated early
• Weakened immune system (from conditions like HIV, cancer, or long-term steroid use)
• Chronic lung diseases such as COPD, bronchiectasis, or cystic fibrosis
• Diabetes
• Alcohol or drug misuse (especially intravenous drug use)
• Recent chest surgery or trauma to the chest

When to see a doctor

See a doctor urgently if:

• Symptoms of pneumonia (fever, cough, chest pain) that are not improving after 2–3 days of antibiotics
• New or worsening chest pain, trouble breathing, or high fever
• Confusion or feeling very weak

Book a routine appointment if:

• Persistent cough or low-grade fever that lasts more than a week
• Unintended weight loss or night sweats
• If you have been in contact with someone with pneumonia and are at high risk

Diagnosis

Doctors diagnose empyema by listening to your chest, taking a medical history, and using imaging tests to look at the fluid in your pleural space.

Tests that may be done

• Chest X-ray – to see if there is fluid between the lung and chest wall
• Ultrasound of the chest – to locate and measure the fluid
• CT scan – a detailed scan to check the size and location of the fluid and see the lung
• Thoracentesis – a procedure where a needle is inserted through the chest wall to take a sample of the fluid. This sample is then tested for bacteria and other signs of infection

What to expect at your appointment

If your doctor suspects empyema, you will likely need to stay in the hospital. A small needle or tube will be placed in your chest to drain the pus. You may also have blood tests and a scan. The procedure is done with numbing medicine, so you should feel only pressure, not sharp pain.

Treatment

Treatment for empyema involves draining the pus from the pleural space and giving antibiotics to fight the infection. The exact treatment depends on how severe the infection is.

Self-care at home

• Get plenty of rest to help your body recover
• Drink enough fluids to stay hydrated
• Take fever-reducing medicine as recommended by your doctor (avoid aspirin in children)
• Use a warm compress on your chest for comfort, but ask your doctor first
• Do not smoke or vape – smoking makes lung infections worse

Medical treatments

You will likely need intravenous (IV) antibiotics given through a vein in your arm. These are strong antibiotics that treat bacterial infections. To drain the pus, a doctor will insert a small tube (chest drain) through your chest wall. This tube stays in place for a few days until the fluid stops coming out. Sometimes a medication is given through the tube to help break up thick pus.

When is surgery considered?

If the chest drain does not remove all the pus, or if the pus is very thick, surgery may be needed. A common minimally invasive procedure is video-assisted thoracoscopic surgery (VATS), where a tiny camera and instruments are used to remove the pus. In rare cases, a larger opening (thoracotomy) may be required.

Living with this condition

Recovery from empyema takes time – often several weeks to months. You may feel tired for a while. It is important to go to all follow-up appointments and finish the full course of antibiotics, even if you feel better.

Lifestyle tips

• Avoid smoking and secondhand smoke – this is very important for your lungs
• Get recommended vaccines, such as the flu vaccine and pneumonia vaccine
• Wash your hands often to avoid infections
• Sleep on your side or propped up if lying flat is uncomfortable

Diet and exercise

Eat a healthy diet with plenty of protein (like eggs, chicken, beans) to help your body repair. Stay hydrated. As you feel stronger, gentle walking can help your breathing and energy – but do not overdo it. Ask your doctor before starting any exercise.

Mental health and emotional wellbeing

Having a serious infection like empyema can be scary and stressful. You may feel anxious or down. This is normal. Talk to your healthcare team about your feelings. They can connect you with support services.

Prevention

Many cases of empyema can be prevented by treating pneumonia quickly and effectively. Taking steps to avoid lung infections also helps.

Vaccines

Vaccines can lower your risk of pneumonia and flu, which are common triggers for empyema. The NHS recommends the pneumococcal vaccine for certain ages and health conditions, and the flu vaccine each year.

Screening programmes

There is no routine screening test for empyema. However, if you are at high risk (for example, after chest surgery), your doctor may monitor you with chest X-rays or ultrasound.

Complications

If left untreated

• The infection can spread to the bloodstream (sepsis), which is life-threatening
• The pus can become very thick and form a hard layer (fibrothorax) that traps the lung
• A lung abscess (pocket of pus in the lung) may develop
• Scarring of the pleural space can cause long-term breathing problems

Long-term outlook

With prompt treatment, the outlook for empyema is good. Most people recover fully, though recovery can take several weeks. Delayed treatment increases the risk of complications, but even severe cases can be treated successfully with a combination of antibiotics and drainage.

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