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Pleural Empyema is a Leading Cause of Respiratory Failure

Sharp chest pain when breathing, along with fever, tiredness, and shortness of breath, could be signs of pleural empyema. It usually occurs after an infection. If not treated in time, it may lead to respiratory failure and eventually death.

Dr. Chawakorn Leampribun, a cardiothoracic surgeon at Vejthani Hospital, explains that pus in the pleural cavity can occur when the body has an infection, especially respiratory infection such as severe flu or pneumonia, which usually happens when we breathe in and out, our lungs expand and contract efficiently. However, when there is pus in the pleural space, the lungs will rub against the pus and will be compressed by the pus, not allowing it to expand and contract as well as before. As a result, there will be sharp pain in the chest when breathing, trouble breathing, inability to breathe, fever, and coughing. The most severe symptom is respiratory failure and having to use a ventilator, as well as the risk of developing bloodstream infection, which can lead to organ failure.

While anyone can develop pleural empyema, people with underlying diseases such as diabetes, kidney failure, and immunodeficiency are at higher risk of being infected than others. In addition, people without underlying diseases can be more vulnerable to pleural empyema during illnesses or weaknesses from lower immunity.

Pleural empyema can be diagnosed through a chest x-ray to see if there is fluid or pus in the pleural space. If the doctor needs more detailed image to confirm the diagnosis, a chest CT scan will be recommended for further investigations.

Treatment for pleural empyema requires the removal of the pus for every case. The doctor will order antibiotics and then will consider which method to use for draining the pus. The procedure can be done in 2 ways:

Chest tube insertion: This involves inserting a tube into the pleural space to drain the pus. However, this method may not completely drain the pus if the patient has a large amount in the pleural cavity.
Surgical drain: In the past, open surgery was performed to drain the pus. This procedure leaves a surgical wound approximately 8 – 10 centimeters long, causes severe pain after surgery, and becomes prone to developing more complications. The treatment methods have advanced these days; the pus can be drained out through endoscopic surgery that leaves small incisions.

Minimally invasive endoscopic surgery (Video-Assisted Thoracoscopic Surgery, VATS) involves the insertion of a camera and surgical instruments through the incision to visualize the pleural space and remove the pus. This method can completely drain out the pus and has results comparable to open surgery. The patient will have an approximately 3 – 4 centimeters long surgical wound on the side of the body. This enables fast recovery with shorter hospital stays, causing minimal pain and fewer complications. After surgery, a drainage tube might be left in place for 1 – 2 days to drain any remaining pus.

“If you start to have the symptoms mentioned above, consult a doctor to receive a proper diagnosis because it may not be a symptom of the common cold. If examined and found that there is pus in the pleural cavity, don’t worry. Although pleural empyema is a serious lung condition, it’s treatable with prompt diagnosis and proper medical care. If not treated in time, it may worsen your symptoms and lead to respiratory failure or, even worse, organ failure,” said Dr. Chawakorn.