Practical management of pleural empyema

Monaldi Arch Chest Dis. 2010 Sep;73(3):124-9. doi: 10.4081/monaldi.2010.296.


Empyema is defined as pus in the thoracic cavity due to pleural space infection and has a multifactorial underlying cause, although the majority of cases are post-bacterial pneumonia. Despite treatment with antibiotics, patients with empyema have a considerable morbidity and mortality due at least in part to inappropriate management of the effusion. Timely diagnosis of pleural space infection and rapid initiation of effective pleural drainage represent fundamental principles for managing patients with empyema. Ultrasound is particularly useful to identify early fibrin membranes and septations in the pleural cavity conditioning treatment strategy. Empyema and large or loculated effusion with a pH < 7.20 need to be drained. Thoracoscopy has largely been used in pleural effusion due to lung infection. Whereas the efficacy of video-assisted thoracic surgery (VATS) in empyema management has been evaluated in several retrospective studies showing favourable results, less is known about the role of medical thoracoscopy (MT) in pleural infection. MT, appears to be safe and successful in multiloculated empyema treatment. It is also lower in cost and in frail patients is better tolerated than VATS which requires tracheal intubation.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Chest Tubes
  • Combined Modality Therapy
  • Drainage
  • Empyema, Pleural / drug therapy
  • Empyema, Pleural / physiopathology
  • Empyema, Pleural / surgery*
  • Humans
  • Thoracic Surgery, Video-Assisted


  • Anti-Bacterial Agents