Overview of Pleural Effusion And Empyema Treatment India

Pleural effusion and empyema are two different diseases of lungs. The treatment of pleural effusion and empyema include draining of fluid. Pleural effusion is collection of excess fluid in the lungs. This fluid is built-up in layers of the pleura. Empyema is a condition in which pus collects in the pleura. This condition develops after pneumonia.

Types of Pleural Effusion And Empyema Treatment India

I. Pleural Effusion

Generally known as water on the lungs, it is a lung disorder in which fluid collects between the layers of lungs known as pleura. Pleura are membranes surrounding the lungs and inside of the cavity. It helps in breathing and acts as lubrication. Normally, a small amount of watery fluid is present in pleural space, and this fluid helps lungs to move smoothly while breathing. The severity of this disease depends on its cause and its effect on breathing.

Symptoms of Pleural Effusion

Some patients may not have any symptoms. Usually, the symptoms are discovered when this disease is moderate or large-sized. The symptoms include:

01. Chest pain

02. Shortness of breath

03. Cough

04. Fever

05. Inability to breathe easily

Causes Pleural Effusion

There are two main categories of causes protein-rich (exudative) or protein-poor (transudative). The common causes of protein-poor pleural effusions are:

01. Heart failure

02. Cirrhosis

03. Pulmonary Embolism

04. Open Heart surgery

The main reasons behind exudative Pleural Effusions are:

01. Pneumonia

02. Pulmonary embolism

03. Cancer

04. Inflammatory disease

05. Kidney disease

The other common causes of this disease are:

01. Autoimmune disease

02. Bleeding in chest due to trauma

03. Tuberculosis

04. Chylothorax

05. Chest infections

06. Meigs syndrome

07. Ovarian Hyperstimulation syndrome

Treatment of Pleural Effusion

Doctors may recommend antibiotics to treat the cause of pleural effusion. However, infected or inflamed pleural effusions need to be drained to prevent other health problems. The procedures to treat it includes:

01. Tube Thoracostomy - Surgeon will make a small cut in the chest wall and put a plastic tube in the space for a few days.

02. Pleural Drain - If pleural effusion comes back, the doctor may put a catheter into the pleural space. The fluid can be then drained at home, and the doctor will tell you how to do that.

03. Pleurodesis - Doctor will inject a substance known as talc into pleural space through chest tube. This substance inflames the chest wall and pleura and binds them tightly. It prevents recurrent of disease.

04. Pleural Decortication - Surgeons will remove unhealthy tissue by performing surgery.

05. VATS - Video-Assisted Thoracoscopic surgery is a minimally-invasive procedure in which a surgeon will make 1 to 3 small incisions in the chest wall. It is an effective procedure to drain pleural effusions. Surgeons can insert a substance known as sterile talc to prevent its recurrence.

06. Thoracotomy - Also known as open thoracic surgery, it is performed through a 6 to 8 inch incision in the chest wall. This procedure is recommended when infection is present. In this procedure, all the fibrous tissue is removed to get rid of infection. There will be chest tubes for 2 to 14 days post-surgery to drain fluid.

II. Empyema

Also known as pyothorax or purulent pleuritis, Empyema is a collection of pus in pleural space. It is a space between lungs and the inner surface of the chest wall. The pus contains fluid filled with bacteria, dead cells and immune cells. This pus cannot be coughed out and needs to be drained by surgery.

Symptoms of Empyema

The common symptoms of empyema includes:

01. Night sweats

02. Fever and chills

03. Chest pain

04. Dry cough

05. Shortness of breath

06. Hiccups

07. Weight loss

08. Fatigue

Causes of Empyema

There are several conditions that can cause empyema, including:

01. Pneumonia

02. Chest surgery for lung cancer or heart disease

03. Chest trauma

04. Infection due to thoracentesis

05. Bronchopleural Fistula - It is a canal that may develop between bronchi and pleural space during lung surgery. This space allows bacteria to transfer from bronchi to pleural space.

06. Infection in the abdomen, It can also occur to someone who has:

6.1. Diabetes

6.2. Alcoholic

6.3. Autoimmune disease

6.4. Weak immune system

6.5. Chronic bronchitis and COPD

6.6. Gastroesophageal reflux disease

Treatment for Empyema

The treatment of an empyema includes both treating it and removing fluid.

01. Fluid Removal - The fluid is removed using thoracentesis. A chest tube will be placed post-procedure to drain fluid. If empyema is present for a long time, it becomes loculated. In loculated, additional attempts of thoracentesis are required to remove the fluid.

02. Medications - Doctors will recommend antibiotics to treat the infection. Once antibiotics treatment is started, doctors will perform further tests to check if antibiotics are working on bacteria.

03. Thoracostomy - In this procedure, the doctor will insert a tube in the chest between two ribs. This tube will be connected to a suction device to remove fluid.

04. VATS - In Video-Assisted Thoracic Surgery, surgeons will remove affected tissue and insert a drainage tube to drain the fluid. Doctor will make three incisions and use a small camera to perform this process.

05. Open Decortication - In this procedure, the surgeon will remove the pleural peel.

Diagnosis of Pleural Effusion And Empyema Treatment India

Diagnosis of Pleural Effusion

Doctor will perform a physical examination by listening with a stethoscope. To confirm about this disease, doctor can suggest any of the below given tests:

01. Chest X-ray - In chest x-ray, air space appears black and pleural effusions look white. Doctors may suggest more X-ray films to check if fluid flows freely in the space.

02. CT Scan - The scanner shows a detailed image of the entire chest inside and out.

03. Ultrasound - A video camera will show images of the inside of the body on a video screen. It is used to locate the fluid.

04. Thoracentesis - In this test, the doctor will take a bit of the fluid to perform the test. A needle and a tube is inserted between ribs to collect the sample of fluid.

Diagnosis of Empyema

Doctor will analyze your medical history and perform a physical examination. To confirm the diagnosis, doctor will perform certain diagnostic tests:

01. Chest X-rays and CT scans - are performed to check if there's fluid in the pleural space or not.

02. Ultrasound - is done to check the amount of fluid and its location in pleural space.

03. Thoracentesis - is performed by inserting a needle into the pleural space and taking a sample of fluid. This fluid pus is analyzed under a microscope to check for protein, bacteria and other dead cells.

04. Blood tests - can be done to check white blood cell count and check the bacteria behind the infection. White cell count can be increased when there is infection.

Symptoms and Risk factors

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Pleural Effusion and Empyema - Frequently Asked Questions

Yes, it can be cured by removing the collection of pus from the lung. It can be done by antibiotics or draining the fluid with surgery.

The first step to diagnose empyema is physical examination. Doctor will suggest diagnostic tests to confirm it. The diagnostic tests include chest X-ray, CT scan and Ultrasound.

Pleural effusion is collection of fluid in the pleural space and is categorized as exudate or transudate. Empyema is build-up of pus in the pleural space and is commonly caused by pneumonia.

The risk factors for empyema include age, pneumonia, comorbid diseases, debilitation and gastroesophageal reflux disease.

The common causes of pleural effusion are cancer, congestive heart failure, pneumonia and more.

A minor pleural effusion goes away of its own. In some cases, doctors will treat the cause to treat pleural effusion.

Patients suffering from malignant pleural effusions have life expectancy ranging from 3 to 12 months.

Avoid alcohol, fat, sugar, fast foods and fried food. Moreover, it is important to maintain a healthy weight to control pleural effusion.