Diagnosis and management of thoracic empyemas

Curr Opin Pulm Med. 1996 May;2(3):198-205. doi: 10.1097/00063198-199605000-00007.


Parapneumonic effusions are frequent complications of bacterial pneumonia. Depending on the severity of the underlying pneumonia, the promptness of antibiotic therapy, and the virulence of the infecting organism, 5% to 50% of patients will require pleural fluid drainage to prevent progression to an empyema. The decision to drain the pleural space depends on multiple clinical, laboratory, and radiographic factors. Delayed drainage results in pleural loculations, prolonged hospitalizations, and increased mortality. Image-guided percutaneous chest catheters provided an effective method for draining both free-flowing and loculated effusions. Fibrinolytic agents are gaining wider acceptance for promoting drainage of loculated, viscous pleural fluid although randomized studies do not exist. Patients failing a chest tube drainage method should undergo early evaluation for an open surgical procedure.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Catheterization / instrumentation
  • Chest Tubes
  • Decision Making
  • Disease Progression
  • Drainage
  • Empyema, Pleural / diagnosis*
  • Empyema, Pleural / diagnostic imaging
  • Empyema, Pleural / etiology
  • Empyema, Pleural / prevention & control
  • Empyema, Pleural / therapy
  • Fibrinolytic Agents / therapeutic use
  • Hospitalization
  • Humans
  • Length of Stay
  • Pleural Effusion / diagnostic imaging
  • Pleural Effusion / etiology
  • Pleural Effusion / therapy
  • Pneumonia, Bacterial / complications
  • Pneumonia, Bacterial / drug therapy
  • Radiography
  • Radiology, Interventional
  • Randomized Controlled Trials as Topic
  • Survival Rate
  • Thoracoscopy
  • Virulence


  • Anti-Bacterial Agents
  • Fibrinolytic Agents