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Empiema

Last reviewed: 14 Sep 2025
Last updated: 07 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • pneumonia recente
  • sintomas constitucionais
  • pirexia e calafrios
  • macicez à percussão
  • redução dos murmúrios vesiculares e da ressonância vocal
  • sinais de sepse
Full details

Other diagnostic factors

  • apresentação subaguda
  • tosse produtiva
  • dor torácica pleurítica
  • dispneia
  • instrumentação recente do espaço pleural
Full details

Risk factors

  • pneumonia
  • intervenções iatrogênicas no espaço pleural
  • trauma torácico
  • pacientes imunocomprometidos
  • comorbidade pulmonar
  • sexo masculino
  • idosos ou muito jovens
Full details

Diagnostic tests

1st tests to order

  • hemoculturas
  • proteína C-reativa
  • contagem leucocitária
  • perfil metabólico
  • radiografia torácica
  • ultrassonografia torácica
  • toracocentese: aparência do líquido pleural
  • toracocentese: odor do líquido pleural
  • toracocentese: pH do líquido pleural
  • toracocentese: concentração de proteínas totais no líquido pleural
  • toracocentese: nível de LDH no líquido pleural
  • toracocentese: concentração de glicose no líquido pleural
  • toracocentese: diferencial de leucócitos no líquido pleural
  • toracocentese: microscopia do líquido pleural, cultura e sensibilidade
Full details

Tests to consider

  • tomografia computadorizada (TC) torácica com contraste
  • ressonância nuclear magnética (RNM) do tórax
  • tomografia por emissão de pósitrons (PET)
  • reação em cadeia da polimerase do líquido pleural
Full details

Treatment algorithm

INITIAL

adultos (resultados da cultura pendentes)

crianças (resultados da cultura pendentes)

ACUTE

adultos (resultados da cultura disponíveis)

crianças (resultados da cultura disponíveis)

Contributors

Authors

Christopher Kapp, MD

Assistant Professor of Medicine, Interventional Pulmonologist

Division of Pulmonary and Critical Care, Section of Interventional Pulmonary

Northwestern Memorial Hospital

Chicago

IL

Disclosures

CK declares that he has no competing interests.

Jeremy Kim, MD

Instructor of Medicine, Interventional Pulmonology Fellow

Division of Pulmonary and Critical Care, Section of Interventional Pulmonary

Northwestern Memorial Hospital

Chicago

IL

Disclosures

JK declares that he has no competing interests.

Acknowledgements

Dr Christopher Kapp and Dr Jeremy Kim would like to gratefully acknowledge Dr Athanasia D. Pataka, Dr Renata L. Riha, Dr Najib M. Rahman, and Dr Eleanor K. Mishra, previous contributors to this topic. ADP, RLR, and EKM declare that they have no competing interests. NMR declares that Roche UK supplied clinical trial supplies and funding for the MIST2 trial that he conducted.

Peer reviewers

Steven Sahn, MD

Professor of Medicine and Director

Division of Pulmonary/Critical Care/Allergy/Sleep Medicine

Medical University of South Carolina

Charleston

SC

Disclosures

SS declares that he has no competing interests.

Nicholas Maskell, MD

Senior Lecturer and Consultant Physician

North Bristol Lung Centre

Southmead Hospital

Bristol

UK

Disclosures

NM declares that he has no competing interests.

Y.C. Gary Lee, MBChB, PhD, FCCP, FRACP

Consultant Chest Physician and Senior Lecturer

Oxford Centre for Respiratory Medicine and University of Oxford Churchill Hospital

Oxford

UK

Disclosures

YCGL declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

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Основные статьи

Shen KR, Bribriesco A, Crabtree T, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017 Jun;153(6):e129-46.Полный текст  Аннотация

Maskell NA, Davies CW, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74.Полный текст  Аннотация

Canadian Paediatric Society. Paediatric complicated pneumonia: diagnosis and management of empyema. Jan 2024 [internet publication].Полный текст

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Empiema images
  • Отличия

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    • Derrame parapneumônico não complicado
    • Abscesso pulmonar
    Больше Отличия
  • Рекомендации

    • ACR Appropriateness Criteria: radiologic management of infected fluid collections
    • The American Association for Thoracic Surgery consensus guidelines for the management of empyema
    Больше Рекомендации
  • Лифлеты для пациента

    Pneumonia

    Больше Лифлеты для пациента
  • Videos

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