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Investigation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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)
  • 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:

  1. Drug and Therapeutics Bulletin 2006;44 (3): 17-20.

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