Spontaneous clostridial empyema and pyopneumothorax.

Five patients developed pleural empyema due to Clostridium perfringens in the absence of penetration of the thorax; two of the patients presented with pyopneumothorax. Thirteen additional cases from the literature are reviewed. Predisposing factors to the development of pleural empyema appear to include aspiration pneumonia, pulmonary embolization and infarction, and bacteremia from other foci. Pleural disease and pulmonary tuberculosis may also predispose patients to pleural empyema. Treatment consists of drainage and antimicrobial chemotherapy.