Pyothorax with & without Fistula

Instructor: Dan Washmuth

Dan has taught college Nutrition, Anatomy, Physiology, and Sports Nutrition courses and has a master's degree in Dietetics & Nutrition.

What is pyothorax? What happens when pyothorax causes a fistula to form? Learn the answers to these questions, and much more, by reading the rest of this lesson!

A Trip to the Doctor

Olivia is a 7-year-old who has recently started to feel quite sick. For the past couple of days, Olivia has been suffering from a cough, chest pains, fever, decreased appetite, and confusion. Worried about her little girl, Olivia's mother takes her to the hospital to get checked out and to receive some treatment to hopefully make Olivia feel better.

At the hospital, doctors put Olivia through several different diagnostic tests to try to find out what is causing her illness. After looking over the test results, a doctor informs Olivia and her mom that Olivia has been experiencing pneumonia. Additionally, the doctor explains that the pneumonia has had caused a rare condition called pyothorax.

What is Pyothorax?

Pyothorax (also called empyema) is a condition in which pus accumulates in the pleural cavity of the chest. Each lung is surrounded by two different membranes (called pleura), and the pleural cavity is the fluid-filled space between these two membranes.

Pyothorax is a condition in which pus accumulates in the pleural cavity.
pleural cavity

Pyothorax is most commonly a complication of pneumonia, which is a bacterial lung infection. The same bacteria that causes pneumonia can also cause infection in the pleural cavity, leading to the development of pyothorax. In addition to pneumonia, this condition may also be caused by an infection following surgery to the chest or an object penetrating the chest cavity (such as a knife wound). Pyothorax is most common in children and older adults.

This infection and accumulation of pus in the pleural cavity can make it very difficult for lungs to expand properly, making it hard for a person to breath. Other common symptoms of pyothorax include:

  • Cough
  • Fever
  • Chest pains
  • Decreased appetite/weight loss
  • Confusion and headaches

This picture shows the common symptoms of pyothorax.
symptoms of pyothorax

Pyothorax with Fistula

Sometimes, the infection inside the pleural cavity can eat away at the membrane, eventually causing a fistula to form. A fistula is an abnormal opening between two organs. Fistulas caused by pyothorax are usually called bronchopleural fistulas because they form between the bronchi (airways in the chest) and the pleura of the lungs. Once a bronchopleural fistula forms, the pus and infectious microorganisms can leave the pleural cavity and spread to other areas of the body. These types of fistulas are very serious because they can cause life-threatening conditions such as septic shock (wide spread infection) and respiratory failure.

Treatment of Pyothorax

Since pyothorax is often the result of a bacterial infection, it is often treated using antibiotics. Additional treatment frequently includes thoracentesis, which is a procedure in which a large needle is inserted into the pleural cavity and used to remove the pus and other fluid that has accumulated. However, the pus and fluid will often come back quickly, so a person will likely require the use of a thoracostomy. A thoracostomy involves the surgical placement of a chest tube that allows for continuous drainage of pus and fluid from the pleural cavity.

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