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Empyema
• Definition
• An empyema is accumulation of pus in the
pleural space
• It is an occasional complication of both
bacterial pneumonia and lung abscess
• The fluid usually is thick and has the
appearance of frank pus
• Pleural fluid with a pH of less than 7.2
strongly suggests an empyema
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 Treatment
• An empyema almost always requires chest
tube drainage as well as antibiotic therapy.
• Drainage may be straightforward early in the
patient’s course
• However , after several days without adequate
drainage, most empyema become loculated , so
that tube drainage becomes more complex and
thoracic surgical intervention may become
necessary.

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Bronchogenic
Carcinoma
(Lung Cancer)

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 Etiology
• Major cause
• Tobacco use (nearly 90% of cases)
• Other causes (occupational exposures)
• Smoke
• Asbestos
• Chromium
• Arsenic
• Iron oxides
• Radiation (radon gas)
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 Histology
• Squamous cell carcinoma (35%)
• Adenocarcinoma (27%)
• Small (oat) cell carcinoma(20%)
• Large cell carcinoma (10%)
• Alveolar cell carcinoma (rare, <1%)
• Note: Clinically the most important
division is between small cell lung
carcinoma (SCLC) and non-small cell lung
carcinoma (NSCLC)
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 History/Physical Examination
• Possibly asymptomatic
• Cough (80%)
• Hemoptysis (70%)
• Dyspnea (60%)
• Pleuritic chest pain (40%)
• Fatigue
• Weight loss
• Frequent pulmonary infections
• Additional symptoms may accompany
paraneoplastic syndromes (see Table 2-10) 8
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 History/Physical Examination
• Local extension of tumors may result in
the following:
• Horner syndrome
• Miosis
• Ptosis
• Anhidrosis
• Pancoast syndrome
• Horner syndrome plus brachial plexus involvement
• Superior vena cava syndrome
• Obstruction of venous drainage through superior vena cava
and associated head swelling and CNS symptoms
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 Radiology
• Initially seen on CXR or CT as pulmonary
nodule
• Bronchoscopy with biopsy and brushings
or fine needle aspiration of lesion are
diagnostic

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 Treatment
• Use of surgical resection, chemotherapy ,
and/or radiation therapy based on type of
lung cancer (large cell, squamous cell, or
adenocarcinoma vs. small cell) and staging
of disease (based on local extension, lymph
node involvement, and presence of
metastases) (see Table 2-11)

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 Complications
• Local complications
• Recurrent laryngeal nerve palsy
• Phrenic nerve palsy
• Superior vena cava obstruction
• Horner’s syndrome (Pancoast’s tumour)
• Rib erosion
• Pericarditis
• Atrial fibrillation
• Metastatic complications
• Brain
• Bone (bone pain, anemia, increased Ca2+)
• Liver
• Adrenals (Addison’s)
• Endocrine complications
• Ectopic hormone secretion, e.g., SIADH(decreased Na+ and increased ADH) and
ACTH(Cushing’s) by small cell tumors
• PTH (increased Ca2+) by squamous cell tumors

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 Complications
• Non-metastatic neurological complications
• Confusion
• Fits
• Cerebellar syndrome
• Proximal myopathy
• Neuropathy
• Polymyositis
• Lambert–Eaton syndrome
• Other complications
• Clubbing
• HPOA (Hypertrophic pulmonary osteoarthropathy)
• Dermatomyositis
• Acanthosis nigricans
• Thrombophlebitis migrans
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 Prognosis
• Non-small cell
• 50% 2 years survival without spread
• 10% 2 years survival with spread
• Small cell
• Median survival is 3 months if untreated
• Median survival is 1–1.5 years if treated

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 Prevention
• Quit smoking
• Prevent occupational exposure to
carcinogens

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 END
Thanks from your
nice Attention

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