Empyema and Abscess Pneumonia Clinical Presentation

Updated: Jan 26, 2021
  • Author: Michael A Ward, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
  • Print
Presentation

History

The patient's history may reveal the following findings:

  • Recent diagnosis and treatment of pneumonia

  • Recent history of penetrating chest trauma or diaphragmatic injury (should raise clinical suspicion for empyema) [16]

  • Cough productive of bloody sputum that frequently has a fetid odor or offensive appearance

  • Fever

  • Shortness of breath

  • Anorexia, weight loss

  • Night sweats

  • Pleuritic chest pain

At the onset, the cough is non-productive, but a productive cough is the typical sign, sometimes followed by hemoptysis. Clubbing fingers may be present in patients with chronic abscess. [4]

Chalmers et al in a prospective observational study identified six risk factors that were associated with patients admitted with community-acquired pneumonia who subsequently developed a complicated parapneumonic effusion or empyema. These factors include albumin < 30 g/L, sodium < 130 mmol/L, platelet count >400 X 109, C-reactive protein >100 mg/L, and a history of alcohol abuse or intravenous drug use. [13] Other predispositions to development of a parapneumonic effusion and empyema include immunosuppression (eg, HIV, diabetes mellitus, malnutrition), gastrointestinal reflux, poor dental hygiene, bronchial aspiration, and chronic lung disease.

Next:

Physical Examination

The physical examination may reveal the following findings:

  • Temperature frequently elevated but usually not greater than 102°F

  • Tachypnea

  • Rales

  • Rhonchi

  • Egophony

  • Tubular breath sounds

  • Decreased breath sounds

  • Dullness to percussion

Previous