Empyema and Abscess Pneumonia Clinical Presentation

Updated: Aug 09, 2023
  • Author: Michael A Ward, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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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) [18]

  • 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. [6]

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. [15] 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.


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