Current diagnostic methods and medical management of thoracic empyemas.

Infections can invade the normally sterile pleural space leading to the development of parapneumonia effusions or empyemas. Pneumonia, thoracic surgery, and trauma, together, are responsible for most cases of empyemas. Pneumococci and staphylococci remain the predominant etiologic organisms. In addition, gram-negative aerobic bacteria and anaerobes are emerging as important pathogens. Most parapneumonic pleural effusions, regardless of their underlying etiology and bacteriology, evolve through definable stages. For each stage of the disease, specific therapeutic measures, either medical or surgical, are available.