Empyema classification
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Empyema Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Classification
Empyema may be classified according to the etiology, anatomical location, and pathological course of the disease as follows:
Primary vs secondary empyema
Primary empyema occurs most commonly as iatrogenic empyema without associated pneumonia whereas secondary empyema happens more commonly secondary to pneumonia.
Empyema necessitans
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.
Stages of empyema
Empyema may be classified according to the stage of the disease as follows:
- Exudative
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
During this stage, bacterial multiplies with increase in polymorphs and fibrin deposition on both pleural surfaces with fluid characteristics of;
- glucose<40
- pH <7.2
- LDH>1000
- Organizing
This stage is characterized by loculations, inelastic membranous peel, and lung entrapment as a result of scarring of the pleural space.