Showing posts with label EMPYEMA. Show all posts
Showing posts with label EMPYEMA. Show all posts

EMPYEMA

Empyema is defined as accumulation of pus or fluid with demonstrable bacteria in pleural space.
Clinical Picture
  • Patients present with fever, chills, pleuritic chest pain and cough
  • It can be acute , subacute or chronic.
  • Leukocytosis with shift to left and Doehle bodies can be noted on CBC.
  • Besides findings of effusion , clubbing, chest wall erythema and edema, increased warmth may be noted on physical exam.
  • CXR will show effusion and cannot be distinguished from other types. Loculated effusions should raise suspicion for empyema.
  • Lack of fever or leukocytosis does not rule out empyema.
Etiology and Pathophysiology
  • Empyema most often is due to extension of infection from pneumonia. Staphylococcal, gram negative and anaerobic infections are common infections presenting in this mode.
  • Anaerobic infections can seed pleura and start as the primary site of infection without a preceding pneumonitis.
  • It could also follow contamination of pleural space from non-sterile pleural taps.
Diagnosis
  • Pleural tap should be done immediately once empyema is a consideration. If the fluid is grossly purulentdiagnosis is established.
  • Gram stain of the pleural fluid and cultures for aerobes and anaerobes should be obtained.
  • If the fluid is not purulent then obtain Ph, glucose and LDH. This will help categorize parapneumonic effusions as simple and complicated effusions.
  • CBC and cultures of sputum and blood are routine.
Treatment

  • Empyema should be drained immediately with chest tube insertion..
  • Appropriate Antibiotics should be started immediately, empiric to start with followed by specific drug based on culture.
  • Streptokinase is useful to break up adhesions if there are loculations.
  • Some patients not responding to this regimen may require thoracotomy to lyse adhesions . This can be accomplished by thoracoscope. Some would require decortication, if a thick pyemic peel has formed and prevent lung expansion.

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