investigation
Last reviewed 01/2018
The investigation of a patients with suspected empyema should include the following:
- imaging
- chest
xray - pleural effusions are usually identified as a result of clinical examination
and chest radiography
- further assessment
- ultrasound scanning is more sensitive and specific than a plain X-ray, allows estimation of volume, localisation of effusions and assessment of loculation, and is often the initial investigation used to guide aspiration
- contrast-enhanced CT scanning may provide additional discrimination (e.g. distinguishing empyema from parenchymal lung abscess)
- further assessment
- chest
xray - pleural effusions are usually identified as a result of clinical examination
and chest radiography
- full blood count:
- reveals a polymorphonuclear leucocytosis
- pleural fluid aspiration:
- may be diagnostic
- the features of a the aspirate from a classical empyema are:
- leucocytosis
- organisms on culture or gram staining
- reduced glucose
- low pH
Reference:
- Drug and Therapeutics Bulletin 2006;44 (3): 17-20.