Pleural empyema is defined as pus accumulation in the
pleural space. Despite the advanced progress in
antibiotic therapy during the last decades, empyema
thoracis remains a widespread serious clinical problem
with significant associated morbidity and mortality of
2–30%. The processes that lead to the formation of
empyema include three phases: an exudative phase,
fibrinopurulent phase, and organization phase [1].
The exudative phase is characterized by increased
permeability of the visceral pleura leading to the
accumulation of a sterile, exudative pleural fluid.
Untreated exudative effusions become complicated
during the subsequent fibrinopurulent phase and
may develop into fibrinopurulent effusions (purulent
and increasingly viscous fluid). Owing to the
disequilibrium between coagulation and fibrinolysis
processes within the pleural space during the
fibrinopurulent phase, fibrin and fibrin strands coat
the pleural surfaces, leading to adhesions and
loculations within the pleural space. This phase
often requires interventional procedure to break
down the adhesions [2].