eMedicine Specialties > Radiology > Chest

Empyema: Multimedia

Author: Marc Tobler, MD, Staff Physician, Department of Diagnostic Radiology, Scott and White Memorial Hospital and Clinic
Coauthor(s): J Michael Holbert, MD, Associate Professor, Department of Radiology, Scott and White Memorial Hospital and Clinic
Contributor Information and Disclosures

Updated: Aug 14, 2007

Multimedia

Picture 1. Posteroanterior (PA) chest radiograph ...
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Picture 1. Posteroanterior (PA) chest radiograph of a man in his 50s who had a 2-week history of partially treated pneumonia. He presented with persistent fever and chest pain. The patchy bilateral lung parenchymal opacities indicate pneumonia. The obliterated left costophrenic angle suggests a left pleural effusion.
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Picture 1. Posteroanterior (PA) chest radiograph ...

Picture 1. Posteroanterior (PA) chest radiograph of a man in his 50s who had a 2-week history of partially treated pneumonia. He presented with persistent fever and chest pain. The patchy bilateral lung parenchymal opacities indicate pneumonia. The obliterated left costophrenic angle suggests a left pleural effusion.

Picture 2. Contrast-enhanced axial CT image at th...
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Picture 2. Contrast-enhanced axial CT image at the level of the inferior pulmonary veins in the same patient as in Image 1 demonstrates loculated fluid in the left major fissure, a pseudotumor (arrow). Gas bubbles are present in the dependent collection of pleural fluid (arrowheads).
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Picture 2. Contrast-enhanced axial CT image at th...

Picture 2. Contrast-enhanced axial CT image at the level of the inferior pulmonary veins in the same patient as in Image 1 demonstrates loculated fluid in the left major fissure, a pseudotumor (arrow). Gas bubbles are present in the dependent collection of pleural fluid (arrowheads).

Picture 3. Enhanced axial CT image a few centimet...
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Picture 3. Enhanced axial CT image a few centimeters inferior to the level in Image 2. Enhancing pleural membranes (arrows) anterior and posterior to the fluid collection indicate the split-pleura sign. The patient had pus in the pleural space; this indicated empyema. Courtesy of Judith Amorosa, MD.
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Picture 3. Enhanced axial CT image a few centimet...

Picture 3. Enhanced axial CT image a few centimeters inferior to the level in Image 2. Enhancing pleural membranes (arrows) anterior and posterior to the fluid collection indicate the split-pleura sign. The patient had pus in the pleural space; this indicated empyema. Courtesy of Judith Amorosa, MD.

Picture 4. Image obtained in a patient with an em...
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Picture 4. Image obtained in a patient with an empyema shows the split-pleura sign in the setting of right lower lobe (RLL) consolidation and atelectasis.
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Picture 4. Image obtained in a patient with an em...

Picture 4. Image obtained in a patient with an empyema shows the split-pleura sign in the setting of right lower lobe (RLL) consolidation and atelectasis.

Picture 5. Enhanced axial CT image obtained at th...
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Picture 5. Enhanced axial CT image obtained at the level of the aortic valve in a septic, alcoholic patient who was brought to the emergency department from a homeless shelter several days after becoming ill. Image shows several gas bubbles in a large right pleural fluid collection. An enhancing pleural membrane (arrow) defines the empyema extending into the chest wall. These are the findings of empyema necessitatis.
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Picture 5. Enhanced axial CT image obtained at th...

Picture 5. Enhanced axial CT image obtained at the level of the aortic valve in a septic, alcoholic patient who was brought to the emergency department from a homeless shelter several days after becoming ill. Image shows several gas bubbles in a large right pleural fluid collection. An enhancing pleural membrane (arrow) defines the empyema extending into the chest wall. These are the findings of empyema necessitatis.

Picture 6. Posteroanterior (PA) chest radiograph ...
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Picture 6. Posteroanterior (PA) chest radiograph in a 52-year-old man who had severe pneumonia in his early 20s shows a large right pleural-based mass. He was treated with antibiotics for 3 days but had a high temperature and chest pain for several weeks. When this image was obtained, the patient was asymptomatic. Courtesy of Judith Amorosa, MD.
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Picture 6. Posteroanterior (PA) chest radiograph ...

Picture 6. Posteroanterior (PA) chest radiograph in a 52-year-old man who had severe pneumonia in his early 20s shows a large right pleural-based mass. He was treated with antibiotics for 3 days but had a high temperature and chest pain for several weeks. When this image was obtained, the patient was asymptomatic. Courtesy of Judith Amorosa, MD.

Picture 7. CT scan (mediastinal window) in the sa...
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Picture 7. CT scan (mediastinal window) in the same patient as in Image 6 shows a mass with a thick, calcified wall arising from the pleura with an air-fluid level. This finding represents an organized, walled-off, old empyema. Courtesy of Judith Amorosa, MD.
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Picture 7. CT scan (mediastinal window) in the sa...

Picture 7. CT scan (mediastinal window) in the same patient as in Image 6 shows a mass with a thick, calcified wall arising from the pleura with an air-fluid level. This finding represents an organized, walled-off, old empyema. Courtesy of Judith Amorosa, MD.

More on Empyema

Overview: Empyema
Imaging: Empyema
Follow-up: Empyema
Multimedia: Empyema
References
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References

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  2. Hasley PB, Albaum MN, Li YH, et al. Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia?. Arch Intern Med. Oct 28 1996;156(19):2206-12. [Medline].

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  7. Davies RJ, Gleeson FV. The diagnosis and management of pleural empyema. Curr Opin Pulm Med. May 1998;4(3):185-90. [Medline].

  8. Han KT, Choi DS, Ryoo JW, Cho JM, Jeon KN, Bae KS. Diffusion-weighted MR imaging of pyogenic intraventricular empyema. Neuroradiology. Jul 24 2007;[Medline].

  9. Heffner JE. Diagnosis and management of thoracic empyemas. Curr Opin Pulm Med. May 1996;2(3):198-205. [Medline].

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  13. Lim TK. Management of parapneumonic pleural effusion. Curr Opin Pulm Med. Jul 2001;7(4):193-7. [Medline].

  14. Ploton C, Freydiere AM, Benito Y, Bendridi N, Mazzocchi C, Bellon G. Streptococcus pneumoniae thoracic empyema in children: rapid diagnosis by using the Binax NOW immunochromatographic membrane test in pleural fluids. Pathol Biol (Paris). Oct-Nov 2006;54(8-9):498-501. [Medline].

  15. Sahn SA. Use of fibrinolytic agents in the management of complicated parapneumonic effusions and empyemas. Thorax. Aug 1998;53 Suppl 2:S65-72. [Medline].

  16. Temes RT, Follis F, Kessler RM, et al. Intrapleural fibrinolytics in management of empyema thoracis. Chest. Jul 1996;110(1):102-6. [Medline].

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Further Reading

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Keywords

organizing effusion, complicated effusion, loculated effusion, pleural pus, intrapleural pus, pleural-space infection

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Contributor Information and Disclosures

Author

Marc Tobler, MD, Staff Physician, Department of Diagnostic Radiology, Scott and White Memorial Hospital and Clinic
Marc Tobler, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

J Michael Holbert, MD, Associate Professor, Department of Radiology, Scott and White Memorial Hospital and Clinic
J Michael Holbert, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Amirsys Royalty Other

Medical Editor

Judith K Amorosa, MD, FACR, Clinical Professor and Program Director, Department of Radiology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School; Consulting Staff, Department of Radiology, Robert Wood Johnson University Hospital
Judith K Amorosa, MD, FACR is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

W Richard Webb, MD, Chief of Thoracic Imaging, Professor, Department of Radiology, University of California at San Francisco
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Barry H Gross, MD, Professor, Department of Radiology, University of Michigan Medical School; Professor, University of Michigan Cancer Center
Barry H Gross, MD is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, Association of University Radiologists, Michigan State Medical Society, Physicians for Social Responsibility, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

 
 
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