What is Empyema Thoracis?

Empyema thoracis is a very terrible illness. Empyema is actually pus. Thoracis is the chest. So by definition it is pus in the chest. However, empyema thoracis actually is pus in the space between the lungs and the chest wall known as the pleural cavity. Pus accumulates in the pleural space pushing against the lungs. As more and more pus is produced, the pus begins to push against the lungs making more difficult to breathe. The infection usually originates in the lungs and then spreads to the pleural space. A person usually has an underlying disease or infection before they develop empyema thoracis including pneumonia, lung cancer, chest wound, surgery, or bone cancer.

As many of you know, I am a Respiratory Therapist. One of my patients, who has multiple sclerosis also has developed empyema thoracis. The Pulmonologist put in a chest tube. The infection was so thick, that they also put in steptokinase to try to thin out the pus to drain it.

Although empyema thoracis signs and symptoms may vary, the most common ones are the following: Fever, coughing, weight loss, shortness of breath, chest pain, and fatigue. As it becomes a larger infection, the work of breathing increases and a person will need to be hospitalized to get help with their breathing and to have this infection drained. In more serious cases, surgery is required and a lobectomy may be necessary (partial lung removal).

When empyema thoracis becomes severe, the pus abscess can spread to other parts of the body and infect other organs. This can cause multi organ failure. Empyema thoracis is very important to get treated as soon as possible. As mentioned above treatments include chest tube, thorocentesis, surgery. Additionally, a very rigorous regime of antibiotics will be given.


Anytime the lungs are effected by an illness, it can become life threatening. It is very important to seek treatment early.

Pneumothorax?

Contrary to popular belief, your lungs are not two balloons. They are more like a bunch of grapes. So when a person has a collapsed lung, it is usually not the whole lung, however, it can be any portion of the lung.

What is a Pneumothorax? A Pnuemothorax is air in the plural space surrounding the lung. This area should not contain air. When it does, the air pushes on the lung causing the little grapes or alveoli to collapse. This depending on the size causes the person to feel several things all at once. Shortness of breath, drop in oxygen saturation in the blood, and chest pain. Because the lung is not able to inflate like it should, oxygen cannot get into the blood stream like it should. Because of this, a pneumothorax is a potentially something that can be life threatening.


What causes a Pneumothorax? Usually, a pneumothorax is caused by some sort of injury to the chest wall. A broken rib that punctures the lung is an example. Another example is a stab wound. If a person does not have an injury to the chest wall but still somehow has a pnuemothorax, this is called a spontaneous pnuemthorax.

A spontaneous pnemothorax can be caused by several things. Tall thin people who smoke are among those who are at risk for a spontaneous pneumothorax. Also people who have lung disease such as cystic fibrosis, emphysema, asthma and pneumonia have a risk for a spontaneous pnumothorax.

How does a Pneumothorax get diagnoised? A chest x-ray is usually what is used to find the pneumothorax. Depending on the size, the pneumothorax is something that needs to be treated right away.

What is the treatment for a Pneumothorax? The doctor will put in a chest tube which will suck out the air in the pleural space allowing the lung to reinflate. This is almost immediate relief for a person having difficulting breathing. If the pneumothorax is a small one, the doctor will usually allow for it to resolve on it's own. However, this person will require observation to make sure that it doesn't worsen. Removal of the chest tube takes place when the xray shows healing and the chest tube is not draining so much.

A pneumothorax is a very serious matter and should never be taken lightly. When a person is short of breath and having chest pain, no matter the cause, they should be taken to ER for a chest xray.

Bronchiectasis - - Explained As Simple As Possible

Bronchiectasis is an abnormal widening of the large airways causing them to loose their elasticity. A person may be born with it (congenital bronchiectasis) or may acquire it later in life as a result of another disorder (including cystic fibrosis). Bronchiectasis is often caused by recurring inflammation or infection of the airways. It may be present at birth, but most often begins in childhood as a complication from infection or inhaling a foreign object.

About 50% of all bronchiectasis patients are cystic fibrosis patients. Other occurrences of bronchiectasis are when the patient repeatedly has pneumonia, tuberculosis, fungal infections, pnemocystic carini. Patients who aspirate on a regular basis also can develop bronchiectasis.

Here are some symptoms of bronchiectasis. This is by no means a complete list:

1. A chronic cough with large amounts of mucous perhaps mixed with blood.

2. Shortness of breath made worse by activity.

3. Weight loss

4. Tiredness

5. Wheezing

6. Clubbing of the fingers


Testing for Bronchiectasis:

When you go and see your doctor, hopefully a Pulmonologist (lung specialist) he/she will want to do a whole bunch of tests on you, and I do mean a whole bunch. Here are a few that they will want the results of to determine if you do have bronchiectasis and the severity of the disease. These tests include, but are not limited to, chest x-rays, chest CT, sputum culture x 3, blood tests, TB test, and even a sweat test (cystic fibrosis testing).

Now that they have put you through all of this testing, how in the world are they going to make you feel better. What kinds of treatments are required for this illness. Your doctor will be able to order several treatments.

1. Chest Physical Therapy and Postural Drainage. This is a speciality of mine since I am a Respiratory Therapist. But to do it at home will require some training of you and your family. I recently had a delightful patient with bronchiectasis and her Pulmologist decided to try the pneumatic vest on her. It worked beautifully. She was coughing up some very uckky stuff in no time at all. She said she was able to breathe better and I was doing the happy dance.

2. Antibiotics. A very heavy duty regime of antibiotics as you do not want the bugs to take up residence in your lungs.

3. Bronchodilators--MDI's or Nebulizer treatments.

4. Bronchoscopy - The doctor can go down into your lungs and suction them out and take pictures of your lungs.

Your doctor may even have more ammunition in his arsenal for fighting bronchiectasis.

What you can expect for your life or the Prognosis. Depending the extent of your illness and the length of time you have had it, you can lead a normal life, or you may need a lung transplant. Again, this is something that you will need to discuss with your Pulmonologist.

I wish you good breathing and clean lungs.