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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
- Pleural space infection; abscess
- Typically infected parapneumonic pleural effusion
- May result from hematogenous seeding of bacteria
- Rare but dangerous complication of chest surgery, trauma, mediastinitis, esophageal perforation
- Complication of other disease process, e.g., sub-diaphragmatic abscess
- Empyema necessitatis
- Empyema that drains spontaneously to chest wall; pleurocutaneous fistula
- Typically: Tuberculosis, fungal infection, actinomycosis
- May involve breast; mastitis
- Tension empyema
- Large or rapidly expanding pleural infection with lung compression and mediastinal shift
- Rarely complicated by cardiac arrest
- Pleural space infection; abscess
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Garvia V et al: Empyema 2020
- Godfrey MS et al: Medical and surgical management of empyema. Semin Respir Crit Care Med. 40(3):361-74, 2019
- Shaw JA et al: Pleural tuberculosis: a concise clinical review. Clin Respir J. 12(5):1779-86, 2018
- Santamarina MG et al: Multidetector CT for evaluation of the extrapleural space. Radiographics. 37(5):1352-70, 2017
- Shen KR et al: The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 153(6):e129-46, 2017
- Wongwaisayawan S et al: Emergency thoracic US: the essentials. Radiographics. 36(3):640-59, 2016
- Helm EJ et al: Imaging of the pleura. J Magn Reson Imaging. 32(6):1275-86, 2010
- Kraus GJ: The split pleura sign. Radiology. 243(1):297-8, 2007
- Chae EJ et al: Radiographic and CT findings of thoracic complications after pneumonectomy. Radiographics. 26(5):1449-68, 2006
- Qureshi NR et al: Imaging of pleural disease. Clin Chest Med. 27(2):193-213, 2006
- Wurnig PN et al: Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg. 81(1):309-13, 2006
- Bramley D et al: Tension empyema as a reversible cause for cardiac arrest. Emerg Med J. 22(12):919-20, 2005
- Cheng G et al: A retrospective analysis of the management of parapneumonic empyemas in a county teaching facility from 1992 to 2004. Chest. 128(5):3284-90, 2005
- Falguera M et al: Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest. 128(5):3233-9, 2005
- Misthos P et al: Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg. 28(4):599-603, 2005
- Tsai TH et al: Community-acquired thoracic empyema in older people. J Am Geriatr Soc. 53(7):1203-9, 2005
- Evans AL et al: Radiology in pleural disease: state of the art. Respirology. 9(3):300-12, 2004
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
- Pleural space infection; abscess
- Typically infected parapneumonic pleural effusion
- May result from hematogenous seeding of bacteria
- Rare but dangerous complication of chest surgery, trauma, mediastinitis, esophageal perforation
- Complication of other disease process, e.g., sub-diaphragmatic abscess
- Empyema necessitatis
- Empyema that drains spontaneously to chest wall; pleurocutaneous fistula
- Typically: Tuberculosis, fungal infection, actinomycosis
- May involve breast; mastitis
- Tension empyema
- Large or rapidly expanding pleural infection with lung compression and mediastinal shift
- Rarely complicated by cardiac arrest
- Pleural space infection; abscess
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
Ultrasonographic Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Garvia V et al: Empyema 2020
- Godfrey MS et al: Medical and surgical management of empyema. Semin Respir Crit Care Med. 40(3):361-74, 2019
- Shaw JA et al: Pleural tuberculosis: a concise clinical review. Clin Respir J. 12(5):1779-86, 2018
- Santamarina MG et al: Multidetector CT for evaluation of the extrapleural space. Radiographics. 37(5):1352-70, 2017
- Shen KR et al: The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 153(6):e129-46, 2017
- Wongwaisayawan S et al: Emergency thoracic US: the essentials. Radiographics. 36(3):640-59, 2016
- Helm EJ et al: Imaging of the pleura. J Magn Reson Imaging. 32(6):1275-86, 2010
- Kraus GJ: The split pleura sign. Radiology. 243(1):297-8, 2007
- Chae EJ et al: Radiographic and CT findings of thoracic complications after pneumonectomy. Radiographics. 26(5):1449-68, 2006
- Qureshi NR et al: Imaging of pleural disease. Clin Chest Med. 27(2):193-213, 2006
- Wurnig PN et al: Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg. 81(1):309-13, 2006
- Bramley D et al: Tension empyema as a reversible cause for cardiac arrest. Emerg Med J. 22(12):919-20, 2005
- Cheng G et al: A retrospective analysis of the management of parapneumonic empyemas in a county teaching facility from 1992 to 2004. Chest. 128(5):3284-90, 2005
- Falguera M et al: Etiology and outcome of community-acquired pneumonia in patients with diabetes mellitus. Chest. 128(5):3233-9, 2005
- Misthos P et al: Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg. 28(4):599-603, 2005
- Tsai TH et al: Community-acquired thoracic empyema in older people. J Am Geriatr Soc. 53(7):1203-9, 2005
- Evans AL et al: Radiology in pleural disease: state of the art. Respirology. 9(3):300-12, 2004
