ABSTRACT
Empyema is defined as the accumulation of pus in a body cavity, derived from the Greek word empyein which means to “put pus in.” In routine medical terminology it refers to pus in the pleural space. Empyema can also develop secondary to infection after thoracic surgery or trauma. Patients with an empyema demonstrate some degree of malaise, persistent fever, respiratory distress, and pleuritic chest pain. Physical exam should exhibit diminished breath sounds with dullness to percussion on the affected side. The definitive management for empyema has traditionally been surgical debridement, which is currently done via the minimally invasive approach, video-assisted thoracoscopy (VATS). VATS has resulted in earlier and more complete resolution of empyema than chest tube drainage alone in both retrospective and prospective studies, translating to shorter hospitalization with primary VATS. Three prospective, randomized trials have been conducted independently comparing fibrinolysis to VATS upon diagnosis of empyema in children.
