An empyema is the accumulation of pus in a body cavity. The most frequent areas which develops this is in the chest cavity. Here, the pus accumulates between the chest wall and the surface of the lung. The accumulation of fluid here can lead to mechanical dysfunction of the lungs, as well as chemical and bacterial problems that affect respiration. Empyema can also develop in the brain. Here it occurs most frequently between the dura, or tough outer lining of the brain, the surface of the brain itself. As the pus accumulates it irritates or damages the brain tissue and may spread in the spinal fluid that surrounds the brain producing meningitis. The pus may also compress the brain, causing focal dysfunction. Irritation of the brain or compromise of its blood supply can lead to seizures. Occlusions of blood vessels, particularly the veins, may develop with subdural empyema. this can lead to strokes of the brain. The world wide use of antibiotic therapy has made the development of empyemas rare in developed countries. Treatment often requires some form of drainage of this loculated cavity of pus.
Causes of Empyema
Empyemas of the chest usually develop as a complication of lung or chest infections, such as pneumonia, tuberculosis, lung abscess, collapsed lung or chest injury. Cancers in some other part of the body may spread to the space outside of the lungs. this can produce a collection of fluid and cancer cells which may secondarily become infected. Collagen vascular disease, such as systemic lupus erythematosus, frequently can lead to pleuritis or pleurisy. Fluid which collects in this space may then become infected. Blood poisoning, or septicemia, can lead to bacteria being deposited and growing in the space around the lungs. Congestive heart failure, kidney disorders, and liver disorders all can similar complications. Subdural empyema of the brain, also, frequently may occur when bacteria are deposited there through the blood stream. Contiguous spread of infection can occur from infections of the bones, sinus infections and middle ear infections.
Signs and Symptoms of Empyema
An empyema that develops in the chest cavity usually produces fever and chills. There is chest pain, most commonly on the side of the infection. The pain frequently increases as one takes a deep breath. The pain may extend into the abdomen and neck. Breathing is commonly rapid and shallow. Fatigue and a feeling of general ill health is common as is weight loss Cough occurs together with the development of bad breath. Bad breath and shortness of breath are also seen with the development of an abscess of the lung. Symptoms seen with an empyema of the subdural space include seizures, headaches, weakness or paralysis, sensory changes and speech problems. There can be visual problems. It the infection spreads to the cerebrospinal fluid, which encircles the brain and spinal cord, signs of meningitis can develop. These include stiff neck, nausea and vomiting, stupor and sensitivity to light. If a large portion of the brain is damaged or its blood supply is compromised, there can be lethargy, stupor and coma. In severe cases, death can ensue.
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Medical Content Last Updated on 07/12/2008
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