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==Overview==
==Overview==


[[Empyema]] may be classified according to the etiology, anatomical location, and pathological course of the disease.<ref name="pmid7634854">{{cite journal| author=Light RW| title=A new classification of parapneumonic effusions and empyema. | journal=Chest | year= 1995 | volume= 108 | issue= 2 | pages= 299-301 | pmid=7634854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7634854  }} </ref> Primary [[empyema]] occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary [[empyema]] happens more commonly secondary to pneumonia. Empyema necessitans is a spontaneous  discharge of an empyema that has burrowed through the [[parietal pleura]] into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of [[pulmonary tuberculosis]]. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue=  | pages=  | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441  }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589  }} </ref> On the basis of etiology [[empyema]] is mostly caused by bacteria. It may be [[tuberculous]] or nontuberculous. [[Tuberculous]] [[empyema]] is the most common cause of [[empyema]] necessitans with majority of affected patients being immunocompromised.<ref name="pmid27555974">{{cite journal| author=Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F| title=Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue=  | pages= 4187108 | pmid=27555974 | doi=10.1155/2016/4187108 | pmc=4983337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555974  }} </ref><ref name="pmid27477414">{{cite journal| author=Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T et al.| title=Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2055-9 | pmid=27477414 | doi=10.2169/internalmedicine.55.6672 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477414  }} </ref> There are 3 stages of empyema which are important in terms of the laboratory findings. These are [[exudative]], fibrinopurulent and organizing.<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911  }} </ref>
[[Empyema]] may be classified according to the etiology, anatomical location, and pathological course of the disease.<ref name="pmid7634854">{{cite journal| author=Light RW| title=A new classification of parapneumonic effusions and empyema. | journal=Chest | year= 1995 | volume= 108 | issue= 2 | pages= 299-301 | pmid=7634854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7634854  }} </ref> Primary thoracic [[empyema]] occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary [[empyema]] happens more commonly secondary to pneumonia. Empyema necessitans is a spontaneous  discharge of an [[Empyema Thoracis|empyema]] that has burrowed through the [[parietal pleura]] into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of [[pulmonary tuberculosis]]. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue=  | pages=  | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441  }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589  }} </ref> On the basis of anatomical location, empyema may be classified depending on the affected organ for example; [[gallbladder empyema]]<ref name="pmid17374864" /><ref name="pmid21427298" />, [[subdural empyema]]<ref name="pmid2891793" /><ref name="pmid27999711" /><ref name="pmid27898560" /><ref name="pmid27826090" /><ref name="pmid27751703" /><ref name="pmid27635411" /><ref name="pmid27651110" /><ref name="pmid27274400" />, joint empyema<ref name="pmid26769350" /><ref name="pmid26012684" /><ref name="pmid24217715" /> and empyema cystitis<ref name="pmid24554081" /><ref name="pmid1118412" />. [[Empyema]] is mostly caused by bacteria. It may be [[tuberculous]] or [[Nontuberculous mycobacteria|nontuberculous]]. [[Tuberculous]] [[empyema]] is the most common cause of [[empyema]] necessitans with majority of affected patients being immunocompromised.<ref name="pmid27555974">{{cite journal| author=Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F| title=Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue=  | pages= 4187108 | pmid=27555974 | doi=10.1155/2016/4187108 | pmc=4983337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555974  }} </ref><ref name="pmid27477414">{{cite journal| author=Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T et al.| title=Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2055-9 | pmid=27477414 | doi=10.2169/internalmedicine.55.6672 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477414  }} </ref> There are 3 stages of empyema which are important in terms of the laboratory findings. These are [[exudative]], fibrinopurulent and organizing.<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911  }} </ref>


==Classification==
==Classification==
Empyema may be classified according to the etiology, anatomical location, and pathological course of the disease as follows:<ref name="pmid7634854">{{cite journal| author=Light RW| title=A new classification of parapneumonic effusions and empyema. | journal=Chest | year= 1995 | volume= 108 | issue= 2 | pages= 299-301 | pmid=7634854 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7634854  }} </ref>


===Primary vs secondary empyema===
===Classification by organ system or location of empyema===  
Primary empyema occurs most commonly as iatrogenic [[empyema]] without associated pneumonia whereas secondary empyema happens more commonly secondary to pneumonia.


===Empyema necessitans===
====[[Pleural empyema]]====
Empyema necessitans is a spontaneous  discharge of an empyema that has burrowed through the parietal pleura into the chest wall to form a [[subcutaneous]] [[abscess]] that may eventually rupture through the skin.<ref name="pmid24326441">{{cite journal| author=Gomes MM, Alves M, Correia JB, Santos L| title=Empyema necessitans: very late complication of pulmonary tuberculosis. | journal=BMJ Case Rep | year= 2013 | volume= 2013 | issue=  | pages=  | pmid=24326441 | doi=10.1136/bcr-2013-202072 | pmc=3863066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326441  }} </ref><ref name="pmid17301589">{{cite journal| author=Ahmed SI, Gripaldo RE, Alao OA| title=Empyema necessitans in the setting of pneumonia and parapneumonic effusion. | journal=Am J Med Sci | year= 2007 | volume= 333 | issue= 2 | pages= 106-8 | pmid=17301589 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17301589  }} </ref>
This is also called empyema thoracis. Thoracic empyema arises from an infection within the lung, often associated with parapneumonic effusions. Parapneumonic effusions may be uncomplicated or complicated effusions. Complicated parapneumonic effusion results when bacteria invade the pleural space with a resultant formation of an empyema thoracis.


===Tuberculous vs nontuberculous empyema===
====Gallbladder empyema====
Tuberculous empyema is the most common cause of [[empyema]] necessitans. This disease can be found in patients with impaired immunity or who are immunocompetent howvever majority of patients affected are immunocompromised.<ref name="pmid27555974">{{cite journal| author=Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F| title=Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male. | journal=Case Rep Infect Dis | year= 2016 | volume= 2016 | issue= | pages= 4187108 | pmid=27555974 | doi=10.1155/2016/4187108 | pmc=4983337 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27555974 }} </ref><ref name="pmid27477414">{{cite journal| author=Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T et al.| title=Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema. | journal=Intern Med | year= 2016 | volume= 55 | issue= 15 | pages= 2055-9 | pmid=27477414 | doi=10.2169/internalmedicine.55.6672 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27477414 }} </ref>
Gallbladder empyema is also called '''suppurative [[cholecystitis]]''' which may  complicate acute/chronic cholecystitis whereby pus collects in the gall bladder lumen. It is common in people with [[diabetes]] and [[atherosclerotic]] disease.<ref name="pmid17374864">{{cite journal| author=Watanabe Y, Nagayama M, Okumura A, Amoh Y, Katsube T, Suga T et al.| title=MR imaging of acute biliary disorders. | journal=Radiographics | year= 2007 | volume= 27 | issue= 2 | pages= 477-95 | pmid=17374864 | doi=10.1148/rg.272055148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17374864 }}</ref><ref name="pmid21427298">{{cite journal| author=O'Connor OJ, Maher MM| title=Imaging of cholecystitis. | journal=AJR Am J Roentgenol | year= 2011 | volume= 196 | issue= 4 | pages= W367-74 | pmid=21427298 | doi=10.2214/AJR.10.4340 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21427298 }} </ref>


==Stages of empyema==
Normally results from an obstruction of the cystic duct hampering drainage of bile from the gall bladder which becomes secondarily infected.
Empyema may be classified according to the stage of the disease as follows:<ref name="pmid27815709">{{cite journal| author=Reichert M, Hecker M, Witte B, Bodner J, Padberg W, Weigand MA et al.| title=Stage-directed therapy of pleural empyema. | journal=Langenbecks Arch Surg | year= 2016 | volume=  | issue=  | pages=  | pmid=27815709 | doi=10.1007/s00423-016-1498-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27815709  }} </ref>


*Exudative
====[[Subdural empyema]]====
   
[[Subdural empyema|Subdural]] empyema  is rare, however it may complicate one-third of all intracranial infections. Subdural empyema may follow pansinusitis, mastoiditis, orbital cellulitis and after surgery for lumbar lipomyelomeningocele manifesting with seizures, focal neurological deficits and altered mentatal status and possible progression to coma.<ref name="pmid2891793">{{cite journal| author=Miller ES, Dias PS, Uttley D| title=Management of subdural empyema: a series of 24 cases. | journal=J Neurol Neurosurg Psychiatry | year= 1987 | volume= 50 | issue= 11 | pages= 1415-8 | pmid=2891793 | doi= | pmc=1032550 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2891793 }}</ref><ref name="pmid27999711">{{cite journal| author=Yüksel MO, Gürbüz MS, Karaarslan N, Caliskan T| title=Rapidly progressing interhemispheric subdural empyema showing a three-fold increase in size within 12 hours: Case report. | journal=Surg Neurol Int | year= 2016 | volume= 7 | issue= Suppl 37 | pages= S872-S875 | pmid=27999711 | doi=10.4103/2152-7806.194495 | pmc=5154207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27999711  }} </ref><ref name="pmid27898560">{{cite journal| author=Yocum D| title=Fusobacterium nucleatum: An unusual cause of subdural empyema. | journal=JAAPA | year= 2016 | volume= 29 | issue= 12 | pages= 1-4 | pmid=27898560 | doi=10.1097/01.JAA.0000508216.58368.74 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27898560  }} </ref><ref name="pmid27826090">{{cite journal| author=Guan J, Spivak ES, Wilkerson C, Park MS| title=Subdural Empyema in the Setting of Multimodal Intracranial Monitoring. | journal=World Neurosurg | year= 2016 | volume=  | issue=  | pages=  | pmid=27826090 | doi=10.1016/j.wneu.2016.10.133 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27826090  }} </ref><ref name="pmid27751703">{{cite journal| author=Byrne N, Plonsker JH, Tan LA, Byrne RW, Munoz LF| title=Orbital Cellulitis with Pansinusitis and Subdural Empyema. | journal=J Emerg Med | year= 2016 | volume=  | issue=  | pages=  | pmid=27751703 | doi=10.1016/j.jemermed.2016.05.067 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27751703  }} </ref><ref name="pmid27635411">{{cite journal| author=Pallangyo P, Lyimo F, Nicholaus P, Kain U, Janabi M| title=Spontaneous Subdural Empyema Following a High-Parasitemia Falciparum Infection in a 58-Year-Old Female From a Malaria-Endemic Region: A Case Report. | journal=J Investig Med High Impact Case Rep | year= 2016 | volume= 4 | issue= 3 | pages= 2324709616666567 | pmid=27635411 | doi=10.1177/2324709616666567 | pmc=5011302 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27635411  }} </ref><ref name="pmid27651110">{{cite journal| author=Doan N, Patel M, Nguyen HS, Mountoure A, Shabani S, Gelsomino M et al.| title=Intracranial subdural empyema mimicking a recurrent chronic subdural hematoma. | journal=J Surg Case Rep | year= 2016 | volume= 2016 | issue= 9 | pages=  | pmid=27651110 | doi=10.1093/jscr/rjw158 | pmc=5029463 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27651110  }} </ref><ref name="pmid27274400">{{cite journal| author=Nguyen HS, Foy A, Havens P| title=Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication. | journal=Surg Neurol Int | year= 2016 | volume= 7 | issue= Suppl 12 | pages= S301-4 | pmid=27274400 | doi=10.4103/2152-7806.182388 | pmc=4879841 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27274400  }} </ref>
In the exudative stage, the pus accumulates, and initial sterile fluid becomes infected with fluid characteristics of;
**glucose>60
**pH>7.2
**LDH<500


*Fibrinopurulent
====Joint empyema====
This usually occurs after superimposed infection of the sinovial fluid following some procedures example post-lumbar or sacroiliac discectomy and instrumentation or surgery.<ref name="pmid26769350">{{cite journal| author=Bayraktutan U, Sade R, Kantarci M| title=Septic arthritis and empyema of the sacroiliac joint after lumbar discectomy and instrumentation. | journal=Spine J | year= 2016 | volume= 16 | issue= 7 | pages= e417-8 | pmid=26769350 | doi=10.1016/j.spinee.2015.12.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26769350  }} </ref><ref name="pmid26012684">{{cite journal| author=Schneider MM, Preiss S, Harder LP, Salzmann GM| title=[Destructive chondrolysis following intraarticular application of lavasorb (polihexanid) for treatment of knee empyema]. | journal=MMW Fortschr Med | year= 2015 | volume= 157 | issue= 8 | pages= 47-8 | pmid=26012684 | doi=10.1007/s15006-015-3033-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26012684  }} </ref><ref name="pmid24217715">{{cite journal| author=Oheim R, Gille J, Schoop R, Badih S, Grimme CH, Schulz AP et al.| title=Surgical therapy of extensive knee joint empyema: mid-term results after two-stage versus one-stage procedures. | journal=Knee Surg Sports Traumatol Arthrosc | year= 2014 | volume= 22 | issue= 12 | pages= 3150-6 | pmid=24217715 | doi=10.1007/s00167-013-2754-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24217715  }} </ref>


During this stage, bacterial multiplies with increase in polymorphs and fibrin deposition on both pleural surfaces with fluid characteristics of;
====Empyema cystitis====
**glucose<40
This type of empyema may complicate a dysfunctional<ref name="pmid24554081">{{cite journal| author=Min Z| title=A forgotten complication of a defunctionalized urinary bladder: pyocystis. | journal=Intern Emerg Med | year= 2014 | volume= 9 | issue= 6 | pages= 691-2 | pmid=24554081 | doi=10.1007/s11739-014-1060-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24554081 }} </ref><ref name="pmid1118412">{{cite journal| author=Szkodny A, Przybyla J| title=[Bladder empyema]. | journal=Pol Przegl Chir | year= 1975 | volume= 47 | issue= 2A | pages= 301-2 | pmid=1118412 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1118412  }} </ref> or an obstructed<ref name="pmid4704614">{{cite journal| author=Sharon V, Kimche D, Kende L| title=[Empyema of the obstructed urinary bladder]. | journal=Harefuah | year= 1973 | volume= 84 | issue= 2 | pages= 75-7 | pmid=4704614 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4704614  }} </ref> urinary bladder.
**pH <7.2
Empyema cystis may be treated by intermittent self-catherterization<ref name="pmid1168734">{{cite journal| author=Herwig KR| title=Empyema cystis treated by intermittent self-catherterization. | journal=J Urol | year= 1975 | volume= 113 | issue= 5 | pages= 719 | pmid=1168734 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1168734  }} </ref> or vaginal vesicostomy for empyema of dysfunctional bladder<ref name="pmid5116304">{{cite journal| author=Spence HM, Allen TD| title=Vaginal vesicostomy for empyema of the defunctionalized bladder. | journal=J Urol | year= 1971 | volume= 106 | issue= 6 | pages= 862-4 | pmid=5116304 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5116304 }} </ref>
**LDH>1000
 
*Organizing
 
This stage is characterized by loculations, inelastic membranous peel, and lung entrapment as a result of scarring of the pleural space.<ref name="pmid2480911">{{cite journal| author=Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA| title=The histology of experimental pleural injury with tetracycline, empyema, and carrageenan. | journal=Exp Mol Pathol | year= 1989 | volume= 51 | issue= 3 | pages= 205-19 | pmid=2480911 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2480911 }} </ref>


==References==
==References==
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[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]

Latest revision as of 17:39, 18 September 2017

Empyema Microchapters

Patient Information

Overview

Classification

Subdural empyema
Pleural empyema

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Empyema may be classified according to the etiology, anatomical location, and pathological course of the disease.[1] Primary thoracic empyema occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary empyema happens more commonly secondary to pneumonia. Empyema necessitans is a spontaneous discharge of an empyema that has burrowed through the parietal pleura into the chest wall to form a subcutaneous abscess that may eventually rupture through the skin.[2][3] On the basis of anatomical location, empyema may be classified depending on the affected organ for example; gallbladder empyema[4][5], subdural empyema[6][7][8][9][10][11][12][13], joint empyema[14][15][16] and empyema cystitis[17][18]. Empyema is mostly caused by bacteria. It may be tuberculous or nontuberculous. Tuberculous empyema is the most common cause of empyema necessitans with majority of affected patients being immunocompromised.[19][20] There are 3 stages of empyema which are important in terms of the laboratory findings. These are exudative, fibrinopurulent and organizing.[21]

Classification

Classification by organ system or location of empyema

Pleural empyema

This is also called empyema thoracis. Thoracic empyema arises from an infection within the lung, often associated with parapneumonic effusions. Parapneumonic effusions may be uncomplicated or complicated effusions. Complicated parapneumonic effusion results when bacteria invade the pleural space with a resultant formation of an empyema thoracis.

Gallbladder empyema

Gallbladder empyema is also called suppurative cholecystitis which may complicate acute/chronic cholecystitis whereby pus collects in the gall bladder lumen. It is common in people with diabetes and atherosclerotic disease.[4][5]

Normally results from an obstruction of the cystic duct hampering drainage of bile from the gall bladder which becomes secondarily infected.

Subdural empyema

Subdural empyema  is rare, however it may complicate one-third of all intracranial infections. Subdural empyema may follow pansinusitis, mastoiditis, orbital cellulitis and after surgery for lumbar lipomyelomeningocele manifesting with seizures, focal neurological deficits and altered mentatal status and possible progression to coma.[6][7][8][9][10][11][12][13]

Joint empyema

This usually occurs after superimposed infection of the sinovial fluid following some procedures example post-lumbar or sacroiliac discectomy and instrumentation or surgery.[14][15][16]

Empyema cystitis

This type of empyema may complicate a dysfunctional[17][18] or an obstructed[22] urinary bladder. Empyema cystis may be treated by intermittent self-catherterization[23] or vaginal vesicostomy for empyema of dysfunctional bladder[24]

References

  1. ↑ Light RW (1995). "A new classification of parapneumonic effusions and empyema". Chest. 108 (2): 299–301. PMID 7634854.
  2. ↑ Gomes MM, Alves M, Correia JB, Santos L (2013). "Empyema necessitans: very late complication of [[pulmonary tuberculosis]]". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-202072. PMC 3863066. PMID 24326441. URL–wikilink conflict (help)
  3. ↑ Ahmed SI, Gripaldo RE, Alao OA (2007). "Empyema necessitans in the setting of pneumonia and parapneumonic effusion". Am J Med Sci. 333 (2): 106–8. PMID 17301589.
  4. ↑ 4.0 4.1 Watanabe Y, Nagayama M, Okumura A, Amoh Y, Katsube T, Suga T; et al. (2007). "MR imaging of acute biliary disorders". Radiographics. 27 (2): 477–95. doi:10.1148/rg.272055148. PMID 17374864.
  5. ↑ 5.0 5.1 O'Connor OJ, Maher MM (2011). "Imaging of cholecystitis". AJR Am J Roentgenol. 196 (4): W367–74. doi:10.2214/AJR.10.4340. PMID 21427298.
  6. ↑ 6.0 6.1 Miller ES, Dias PS, Uttley D (1987). "Management of subdural empyema: a series of 24 cases". J Neurol Neurosurg Psychiatry. 50 (11): 1415–8. PMC 1032550. PMID 2891793.
  7. ↑ 7.0 7.1 Yüksel MO, Gürbüz MS, Karaarslan N, Caliskan T (2016). "Rapidly progressing interhemispheric subdural empyema showing a three-fold increase in size within 12 hours: Case report". Surg Neurol Int. 7 (Suppl 37): S872–S875. doi:10.4103/2152-7806.194495. PMC 5154207. PMID 27999711.
  8. ↑ 8.0 8.1 Yocum D (2016). "Fusobacterium nucleatum: An unusual cause of subdural empyema". JAAPA. 29 (12): 1–4. doi:10.1097/01.JAA.0000508216.58368.74. PMID 27898560.
  9. ↑ 9.0 9.1 Guan J, Spivak ES, Wilkerson C, Park MS (2016). "Subdural Empyema in the Setting of Multimodal Intracranial Monitoring". World Neurosurg. doi:10.1016/j.wneu.2016.10.133. PMID 27826090.
  10. ↑ 10.0 10.1 Byrne N, Plonsker JH, Tan LA, Byrne RW, Munoz LF (2016). "Orbital Cellulitis with Pansinusitis and Subdural Empyema". J Emerg Med. doi:10.1016/j.jemermed.2016.05.067. PMID 27751703.
  11. ↑ 11.0 11.1 Pallangyo P, Lyimo F, Nicholaus P, Kain U, Janabi M (2016). "Spontaneous Subdural Empyema Following a High-Parasitemia Falciparum Infection in a 58-Year-Old Female From a Malaria-Endemic Region: A Case Report". J Investig Med High Impact Case Rep. 4 (3): 2324709616666567. doi:10.1177/2324709616666567. PMC 5011302. PMID 27635411.
  12. ↑ 12.0 12.1 Doan N, Patel M, Nguyen HS, Mountoure A, Shabani S, Gelsomino M; et al. (2016). "Intracranial subdural empyema mimicking a recurrent chronic subdural hematoma". J Surg Case Rep. 2016 (9). doi:10.1093/jscr/rjw158. PMC 5029463. PMID 27651110.
  13. ↑ 13.0 13.1 Nguyen HS, Foy A, Havens P (2016). "Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication". Surg Neurol Int. 7 (Suppl 12): S301–4. doi:10.4103/2152-7806.182388. PMC 4879841. PMID 27274400.
  14. ↑ 14.0 14.1 Bayraktutan U, Sade R, Kantarci M (2016). "Septic arthritis and empyema of the sacroiliac joint after lumbar discectomy and instrumentation". Spine J. 16 (7): e417–8. doi:10.1016/j.spinee.2015.12.033. PMID 26769350.
  15. ↑ 15.0 15.1 Schneider MM, Preiss S, Harder LP, Salzmann GM (2015). "[Destructive chondrolysis following intraarticular application of lavasorb (polihexanid) for treatment of knee empyema]". MMW Fortschr Med. 157 (8): 47–8. doi:10.1007/s15006-015-3033-2. PMID 26012684.
  16. ↑ 16.0 16.1 Oheim R, Gille J, Schoop R, Badih S, Grimme CH, Schulz AP; et al. (2014). "Surgical therapy of extensive knee joint empyema: mid-term results after two-stage versus one-stage procedures". Knee Surg Sports Traumatol Arthrosc. 22 (12): 3150–6. doi:10.1007/s00167-013-2754-y. PMID 24217715.
  17. ↑ 17.0 17.1 Min Z (2014). "A forgotten complication of a defunctionalized urinary bladder: pyocystis". Intern Emerg Med. 9 (6): 691–2. doi:10.1007/s11739-014-1060-0. PMID 24554081.
  18. ↑ 18.0 18.1 Szkodny A, Przybyla J (1975). "[Bladder empyema]". Pol Przegl Chir. 47 (2A): 301–2. PMID 1118412.
  19. ↑ Babamahmoodi F, Davoodi L, Sheikholeslami R, Ahangarkani F (2016). "Tuberculous Empyema Necessitatis in a 40-Year-Old Immunocompetent Male". Case Rep Infect Dis. 2016: 4187108. doi:10.1155/2016/4187108. PMC 4983337. PMID 27555974.
  20. ↑ Nishihara T, Hayama M, Okamoto N, Tanaka A, Nishida T, Shiroyama T; et al. (2016). "Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema". Intern Med. 55 (15): 2055–9. doi:10.2169/internalmedicine.55.6672. PMID 27477414.
  21. ↑ Strange C, Tomlinson JR, Wilson C, Harley R, Miller KS, Sahn SA (1989). "The histology of experimental pleural injury with tetracycline, empyema, and carrageenan". Exp Mol Pathol. 51 (3): 205–19. PMID 2480911.
  22. ↑ Sharon V, Kimche D, Kende L (1973). "[Empyema of the obstructed urinary bladder]". Harefuah. 84 (2): 75–7. PMID 4704614.
  23. ↑ Herwig KR (1975). "Empyema cystis treated by intermittent self-catherterization". J Urol. 113 (5): 719. PMID 1168734.
  24. ↑ Spence HM, Allen TD (1971). "Vaginal vesicostomy for empyema of the defunctionalized bladder". J Urol. 106 (6): 862–4. PMID 5116304.
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