This section is still under construction…but here is what I have so far.
Exudative <2 weeks
Fibrinopurulent 2-5 weeks
Organizing/Chronic >5 weeks
Acute Thoracic Empyema
Subacute Thoracic Empyema
General: usually due to underlying infection – pneumonia, undrained blood/debris
Drainage and antibiotics
Chest tube is the main initial step. Thoracentesis is a poor choice to help the patient.
Repeat imaging: CT chest no contrast 2-3 days after chest tube insertion
If not >90% expanded, consider another chest tube guided to the undrained area, or surgical drainage, either VATS or thoracotomy.
The majority of surgical cases are in the fibrinopurulent phase. See images below.
Image 1 – Fibrinopurulent Phase Empyema
Image 1: chest wall partially decorticated at the top, and the lung contracted with a purulent and hemorrhagic appearing layer of ‘peel’.
Image 2 – Fibrinopurulent Phase Empyema
Image 2: Thoracoscopic drainage and decortication. Peel still present on chest wall and lung.
Image 3 – Fibrinopurulent Phase Empyema
Image 3: breaking up septae with between loculations – upper left, purulent fluid pooling after breaking up loculations.