Empyema and Pneumothorax


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

Chronic 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

Empyema and peel 1

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

Empyema and peel 2

Image 2: Thoracoscopic drainage and decortication.  Peel still present on chest wall and lung.


Image 3 – Fibrinopurulent Phase Empyema

Empyema and peel 3

Image 3: breaking up septae with between loculations – upper left, purulent fluid pooling after breaking up loculations.



Under Construction…

Apical Bleb 1