Pathophysiology

The development of empyema can be described in a sequence of events. During an inflammatory

process such as pneumonia, there is an increase in fluid production in the pleural cavity known as the
exudate stage. As the disease progresses microorganisms, usually bacteria, can colonize the fluid and
generated an empyema. This fluid is characterized by elevated lactate dehydrogenase, proteins,
neutrophils, and dead cells. Macroscopically is a thick opaque fluid found in the fibrinopurulent stage.
After the resolution of the infection and as a consequence of the inflammation, there is a process of
fibrosis that can lead to restriction of the lung parenchyma. Appropriate and early intervention is vital to
decrease complications and mortality.[