Empyema Thoracis: A Comprehensive Literature Review
DOI:
10.29303/jbt.v26i3.12953Published:
2026-08-05Downloads
Abstract
Empyema thoracis is a severe pleural infection characterized by the accumulation of purulent fluid within the pleural cavity, most commonly as a complication of pneumonia. Delayed diagnosis and inadequate treatment contribute to increased morbidity and mortality. This review aimed to synthesize recent evidence on the epidemiology, pathophysiology, diagnosis, and management of empyema thoracis, highlighting current advances in clinical practice. A literature review was conducted using articles retrieved from PubMed, Scopus, ScienceDirect, and Google Scholar published between 2015 and 2025. A total of 48 eligible articles, including original studies, systematic reviews, and international clinical guidelines, were analyzed. The findings indicate that disease stage at presentation and timely pleural drainage are the most consistent prognostic factors. Early-stage empyema is generally managed successfully with antibiotics and image-guided pleural drainage, whereas delayed treatment often requires surgical intervention, including video-assisted thoracoscopic surgery or decortication. The novelty of this review lies in integrating recent evidence and clinical guidelines to compare stage-based diagnostic and therapeutic approaches. Early multidisciplinary management with treatment tailored to the stage of empyema is essential to improve clinical outcomes, reduce complications, and support evidence-based decision-making in clinical practice.
Keywords:
Empyema Thoracis Management Pleural Infection PneumoniaReferences
Adam, A., Dixon, A. K., Gillard, J. H., & Schaefer-Prokop, C. (2020). Grainger & Allison's Diagnostic Radiology, 2 Volume Set E-Book. Elsevier Health Sciences.
Arnold, F. W., Bordon, J., Reyes, L. F., Wiemken, T. L., Peyrani, P., & Ramirez, J. A. (2020). The role of Streptococcus anginosus in the pathogenesis of empyema thoracis. Infectious Disease Reports, 12(2), 56–63.
Bedawi, E. O., Ricciardi, S., Hassan, M., Gooseman, M. R., Asciak, R., Castro-Añón, O., ... & Rahman, N. M. (2023). ERS/ESTS statement on the management of pleural infection in adults. European Respiratory Journal, 61(2).
British Thoracic Society (BTS). (2023). British Thoracic Society Guideline for Pleural Disease. Thorax, 78(Suppl 3).
Cafarotti, S., Condoluci, A., & Inderbitzi, R. (2017). Physiology and pathophysiology of the pleura. In Chest drains in daily clinical practice (pp. 17–28). Springer International Publishing.
D’Agostino, H. P., & Edens, M. A. (2023). Physiology, pleural fluid. InStatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513353/
Habib, M. A., Javed, M., Malik, A., Khan, M. S., & Irfan, M. (2018). Microbial etiology and outcomes in patients with empyema thoracis. Clinical Infectious Diseases, 66(7), 1014–1021.
Hasan, H., & Ambarwati, D. (2018). Empiema. Jurnal Respirasi, 4(1), 26–32. https://doi.org/10.20473/jr.v4-I.1.2018.26-32
Haseen, M., Alam, S., Aslam, M., & Beg, M. (2020). Use of thopaz in patients of empyema thoracis undergoing decortication. Lung India, 37(6), 511.
Hashemian, H., & Sanati, F. (2023). Comparing the mean platelet volume and the neutrophil-to-lymphocyte ratio in children with bacterial pneumonia associated with or without pleural empyema. Journal of Guilan University of Medical Sciences, 31(4), 328–337.
Ho, A. Y., Lam, D. C., Chan, K. K., & Ip, M. S. (2017). Prevalence and risk factors for empyema thoracis in patients with chronic obstructive pulmonary disease. Chest, 151(6), 1195–1202.
https://doi.org/10.32598/jgums.31.3.1813.1
Iguina, M. M., Sharma, S., & Danckers, M. (2024). Thoracic empyema. InStatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544279/
Lampridis, I., Mitsos, S., Radu, D., & Panagiotopoulos, N. (2021). Management and surgical treatment of empyema thoracis: An overview of current approaches. Thoracic Surgery Clinics, 31(1), 23–34.
Lestari, R., Fathana, P. B., Ajmala, I. E., & Hidayat, M. (2024). Penyakit pleura: Empiema (Edisi pertama). Madza Media.
Martini, F. (2023). Fundamentals of anatomy & physiology. Pearson Educational.
McCormack, D. J., & Anderson, J. R. (2017). Empyema thoracis. Surgery. http://dx.doi.org/10.1016/j.mpsur.2017.02.003
Morimoto, J., Fujiwara, T., Karita, R., Yusa, J., Shiba, M., & Iida, T. (2024). Successful treatment with fenestration followed by daily decortication and negative-pressure wound therapy for acute exacerbation of chronic empyema: A case report. General Thoracic and Cardiovascular Surgery Cases, 3(1). https://doi.org/10.1186/s44215-024-00151-9
Neupane, K., & Jamil, R. T. (2023). Physiology, transpulmonary pressure. InStatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559004/
Rahman, N. M., & Maskell, N. A. (2018). Pleural infection: Past, present, and future directions. Annals of the American Thoracic Society, 15(5), 563–568. https://doi.org/10.1513/AnnalsATS.201711-848PS
Scarci, M., Abah, U., Solli, P., Page, A., & Waller, D. A. (2015). Surgical interventions for empyema thoracis: A comprehensive review. European Respiratory Review, 24(136), 212–220.
Shen, K. R., Bribriesco, A., Crabtree, T. D., Denlinger, C. E., Eby, J., Eiken, P., ... & The American Association for Thoracic Surgery. (2017). The American Association for Thoracic Surgery consensus guidelines for the management of empyema. The Journal of Thoracic and Cardiovascular Surgery, 153(6), e129–e146. https://doi.org/10.1016/j.jtcvs.2017.02.043
Shiroshita, Y., Imai, K., Yamamoto, M., Yamaguchi, H., Nakashima, T., & Ohta, M. (2024). Current trends in the management of empyema thoracis. Journal of Respiratory Medicine, 40(2), 78–86.
Son, S. I., Lee, M. K., Kim, S. W., & Kwon, Y. S. (2021). Risk factors for the development of empyema in patients with pneumonia. International Journal of Infectious Diseases, 35(3), 91–98.
Tsai, Y., Gamper, N., Huang, T., Lee, S., & Chang, H. (2019). Predictors and clinical outcomes in empyema thoracis patients presenting to the emergency department undergoing video-assisted thoracoscopic surgery. Journal of Clinical Medicine, 8(10), 1612. https://doi.org/10.3390/jcm8101612
VanPutte, C., Regan, J., & Russo, A. (2021). Seeley’s essentials of anatomy and physiology ISE (11th ed.). McGraw-Hill Education.
Weerakkody, Y., Silverstone, L., Verikios, N., et al. (2024). Pleural empyema. Radiopaedia. https://doi.org/10.53347/rID-7336
Wei, W., Shen, P., Liu, S., Li, N., Zeng, Y., Ma, L., & Wang, J. (2024). Analysis of the clinical manifestations and diagnostic process of the pleural effusion associated with constrictive pericarditis. Frontiers in Medicine, 11, 1419750
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Copyright (c) 2026 Alfi Salma Q Rani, Baiq Salwa Nadira Alifa, M. Badzlul Rahmansyah, Atiella Denisa Puriarta Lazuara, Rina Lestari
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