Pleural empyema

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Classification according to ICD-10
J86 Pyothorax
ICD-10 online (WHO version 2019)

In a pleural empyema is a collection of pus ( empyema ) within the pleura ( pleura ), that is between the two pleural, the pleura ( visceral pleura ) and the pleura ( parietal pleura ). A pleural empyema is synonymous as pyothorax , purulent pleurisy and pleurisy purulent referred.


A pleural empyema arises in the context of bacterial infections and is a complication of pleurisy ( pleurisy ). In most cases, pleural empyema are the result of bacterial pneumonia ( pneumonia ) when there is a transfer of the bacteria from the lung tissue of the pleura. They are then also referred to as parapneumonic pleural empyema . Since lobar pneumonia typically involves a reaction of the pleura in the form of pleurisy, it is this pneumonia that most frequently leads to pleural empyema in 2–5% of cases. Correspondingly frequent pathogens are therefore pneumococci ( Streptococcus pneumoniae ) and other pathogens of lobar pneumonia, such as staphylococci and Klebsiella .

In addition, pleural empyema can be complications of lung abscesses , esophageal perforation , thoracotomy, and sepsis . The latter is also referred to as a septic metastasis .


The patients mostly suffer from cough with sputum, chest pain , shortness of breath , high fever , night sweats and weight loss . In the context of antibiotic therapy , the symptoms are often not at all or only slightly pronounced, so that the pleural empyema can initially be almost clinically silent.


CT image: the arrows indicate chambered pleural empyema

During the physical examination, a weakened breathing sound during auscultation and a muffled (hyposonorous) tapping sound during percussion over the pleural empyema are typical but unspecific. For the diagnosis of a conventional Pleuraempyemen usually sufficient x-ray of the chest . Pleural empyemas are characterized by a clear decrease in transparency. The accumulation of pus shows up in the form of a mirror on the X-ray. If the findings are unclear, a computed tomography of the chest can be made.

To confirm the diagnosis, a precise pleural puncture is carried out with subsequent microbiological diagnosis to determine the pathogen. If the pus is sterile, i.e. no pathogen detection is possible, this is suspected of tuberculosis .


The therapy consists of a Thoraxsaugdrainage of purulent pleural effusion and an antibiotic . In the case of chambered pleural empyema, thoracoscopy with irrigation and targeted drainage insert may be necessary. Older, chronic pleural empyemes form so-called "pleural rinds", in this case a thoracotomy with partial pleurectomy , chest drainage and, if necessary, the insertion of a drug carrier (e.g. a collagen fleece with gentamicin additive) may be necessary.

The healing result of a pleural empyema is usually a pleurodesis , i.e. an adhesion of the visceral and parietal pleura with the consequent loss of gliding ability between the lungs and chest wall.

Chest x-rays showing pleural therapyema progression within 2 weeks


  • H. Renz-Polster u. a: Basic textbook internal medicine. 3. Edition. Urban & Fischer-Verlag, Munich 2004, ISBN 3-437-41052-0 , p. 502.
  • E. Grundmann (Ed.): Introduction to general pathology. 9th edition. Urban & Fischer-Verlag, Munich 2000, ISBN 3-437-21191-9 , p. 121 ff.
  • Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 97-100 ( infections of the pleura ).
  • Joachim Frey : Diseases of the respiratory organs. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 599-746, here: pp. 731-733 ( pleural empyema ).

Individual evidence

  1. Wolfgang Piper: Internal medicine. Springer , 2012, ISBN 978-3-642-33107-7 , p. 259.