ACUTE EMPYEMA

Dr. SAMIR MUHIELDEEN

 Acute empyema
• Accumulation of pus in the pleural space. It pass into 3 stages:
1. Acute phase: fever and toxic.
↑
2. Transitional phase: turbidity of fld. +small lung.
↓
3. Chronic phase; pl. thickening+ fld. &trapped lung.
• Causes:
1.50% secondary to pul. Cause( pn. , suppuration)
2.Complication of septicemia.
3.Mediastinitis- perforation of esoph.
4.FB inhalation (lung abscess)
5.Post-op complications
6.Penetrating injury
7.Subphrenic abscess.
– Pnemococcal, staphylococal, anaerobics.
• O/E:
– Febrile, toxic, SOB, chest pain, cough.
– ↓
air entry.
• Dx:
CXR.
Aspiration of pus.
Bronchoscopy.
• Rx:
– Bed rest.
– AB
– Thoracocentesis.
– Tube thoracostomy.
• If TB empyema not associated with BPF and purulent fld. :
– Anti TB
– Thoracocentesis.
• If thick: tube thoracostomy (closed or open)
• If fistula: thoracotomy.
• Complication of empyema:
1. BPF.
2. Empyema necessitates.
3. Pericarditis.
4. Mediastinal abscess.
5. Esophago-pleural fistula.
6. Osteomylitis of rib or sternum.
7. TB of pleura.
 CHRONIC EMPYEMA.
• Occur when acute empyema was not recognized and
treated properly, complete obliteration of the pleural cavity
was not attained.
1. Premature removal of CT
2. TB pleura.
3. BPF.
• Before deciding type of Rx. For cure of chr. Empyema, the
condition of the underlying lung must be assessed.
• Rx;
– Decortication.
– If not fully expanded only partly, do partial thoracoplasty.
– Pleuropneumonectomy.
 Chylothorax
• The presence of lymph fld. In the pl. space.
• Thoracic duct originates from cicterna chyle in abdomen, and passes through the
diaphragm into the chest to terminate at or near the left jugulo-subclavian
junction.
• Causes:
1. Trauma.
2. Neoplasm.
3. Cong. Anomalies of lymphatic in mediast. Or lung.
4. Thrombosis or obstruction of large vv. SVC.
5. Rare pul. Lesions permitting the retrograde flow(TB)
6. Newborn result of injury at birth or complication of cong. Lymphangectasia of lung &
Pl.
• Dx:
– Milky, not clot, contain fat, fat soluble vitamins, prt, and antibody.
• Rx:
– Low fat diet
– Closed intercostal drainage
– Nutritional support
– Thoracotomy.
 Primary pleural tumor
• Relatively rare, arise from cells of various elements of visceral,
mediastinal, diaphragmatic, parietal.
– Fibroma, fibrosarcoma.
– Mesothelioma
– Localized or diffused.
• C/F;
– Young age.
– Slowly growing
– Large size without metastasis.
– Asymptomatic, or symptomatic:
a. Pain, swelling of various joints.
b. Arthralgia- fever
c. Finger clubbing
d. Pul. Osteoarthroplasty
e. Rare bronchial symptoms ( cough, dyspnea, fever, chilling)
• DIFFUSE:
1. Chest pain
2. Dyspnea
3. Weakness
4. Wt. loss
5. Hemoptysis
• Dx:
– CXR
– Bronchoscopy
– Pl. biopsy
– CT, MRI
• Rx:
– Surgical excision, follow DXT
• METASTATIC:
– From lung, breast, lymphoma.
• Rx:
– DXT, CXT, hormonal therapy