Abstract
Empyema is a frankly purulent infection of the pleural space most often occurring
secondary to parapneumonic effusion. Imaging, specifically contrast-enhanced computed
tomography, plays a critical role in diagnosis with a “split pleura” sign being highly
suggestive in the appropriate clinical setting. Diagnostic thoracentesis with culture
and Gram stain further guides appropriate antibiotic therapy. Therapeutic drainage
with small-bore tube thoracostomy has been shown to be a safe and effective treatment
of early stage empyema. Augmentation of tube placement with intrapleural fibrinolytics
and mucolytics facilitates catheter drainage by degrading loculations and decreasing
fluid viscosity, respectively.
Keywords
empyema - chest tube - fibrinolytics - mucolytics - split pleura sign
