Empyema is the medical term for pockets of pus that have collected inside a body cavity. They can form if a bacterial infection is left untreated, or if it fails to fully respond to treatment. The term empyema is most commonly used to refer to pus-filled pockets that develop in the pleural space.


Empyema is usually caused by an infection that spreads from the lung. It leads to a buildup of pus in the pleural space.

There can be 2 cups (1/2 liter) or more of infected fluid. This fluid puts pressure on the lungs.

Risk factors include:

  • Bacterial pneumonia
  • Tuberculosis
  • Chest surgery
  • Lung abscess
  • Trauma or injury to the chest


Empyema can be simple or complex. 

Simple empyema

Simple empyema occurs in the early stages of the illness. A person has this type if the pus is free-flowing. The symptoms of simple empyema include:

  • shortness of breath
  • dry cough
  • fever
  • sweating
  • chest pain when breathing that may be described as stabbing
  • headache
  • confusion
  • loss of appetite

Complex empyema

Complex empyema occurs in the later stage of the illness. In complex empyema, the inflammation is more severe. Scar tissue may form and divide the chest cavity into smaller cavities. This is called loculation, and it’s more difficult to treat. 

If the infection continues to get worse, it can lead to the formation of a thick peel over the pleura, called a pleural peel. This peel prevents the lung from expanding. Surgery is required to fix it. 

Other symptoms in complex empyema include:

  • difficulty breathing
  • decreased breath sounds
  • weight loss
  • chest pain


Your doctor will use the following methods to see if you have empyema:

  • CT scans
  • X-rays
  • Thoracentesis, which is when your doctor removes air or fluid around the lungs using a needle to look at the pus in your pleural space
  • Pleural fluid Gram stain and culture, which will help your doctor to figure out what kind of fungal or bacterial infections are causing your empyema

The RAPID system looks at the following:

  • Renal or kidney function (1 point)
  • Pus, specifically how much of it there is and how white it is (or albescence) (1 point)
  • Infection, whether you got it at the hospital or outside of it (1 point)
  • Diet, which specifically looks at your albumin levels. Albumin is a protein your liver creates. Higher levels of albumin indicate that your body is fighting against more inflammation (1 point)


Treatment for empyema can include:


Antibiotics are the first treatment for simple empyema. Because different strains of bacteria may be responsible, finding the right antibiotic is crucial.

The treatment typically takes 2-6 weeks to work.


Draining the fluid is essential to prevent simple empyema from progressing. It also helps keep the condition under control.

To drain the fluid, a doctor performs a tube thoracostomy, which involves inserting an ultrasound- or computer-guided tube into the chest cavity and removing the liquid from the pleural space.


For advanced cases, surgery may be the best treatment option. One study source found that a procedure called decortication yielded better results than tube drainage in people with advanced empyema.

Decortication involves removing the pus pockets and fibrous tissue from the pleural space, which helps the lungs expand.

For draining the fluid, there are two options. In most cases , a surgeon performs a video-assisted thoracotomy (VATS), which is less invasive than the alternative. VATS also involves less pain and a shorter recovery period.


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