EMPYEMA THORACIS

AIN NAJWA BT ABD RAHIM (090100457)

MARDHIAH BT MARZUKI (090100470)
 Definition
• Accumulation of Pus in the Pleural
cavity.
• It comes from the greek word
empyein ,which means :pus –producing
(suppurates).
 Aetiology
• Lung diseases:
– Pneumonia (the most common cause)
– Lung abscess.
• Post traumatic.
• Post-operative (lung surgery)
• Inoculation of the pleural cavity
after thoracentesis or chest tube
placement
 Organisms
The most common:
• Staph.aureus .(90% of causes in
infants & children)
• Strept.pneuomonie.
• H.influenzae.
 Pathological Stages
• Acute (exudative) stage:
– Pleura fills with thin fluid that
shows one or more of these
criteria;
• Ph < 7.4
• Glucose <40 mg/dl
• LDH> 1000 iu/dl
• Protein > 2.5 gm/dl
• Sp.gravity >1.018
 Stages (cont.)
• Fibrinopurulent stage:
– Thick,Opaque fluid with positive
culture (pus) and deposition of thin
fibrin layer over the pleura.
– Progressive loculation and formation
of pouches in the pleura.
 Stages (cont.)
• Organizing Stage:
– Presence of very thick pus .
– pus and fibrin result in a non elastic
pleural peel.
 Clinical stages
• Acute stage :
– within the first 2 weeks of the onset.

• Chronic Stage :
– after 2 weeks of onset.
 Causes of chronicity:
• Inadequate Tube Drainage.

• Chronic pulmonary Disease( T.B. or

Fungal Infection)
• Immunosupressed patients.

• Presence of Foreign body within

the pleural space.
 Symptoms & signs
• Fever
• Cough & Expectoration.
• Pleuretic chest pain.
• Easy fatiguability.
• Loss of weight.
• Night sweating.
 Differential Diagnosis
• Pleura effusion
• Aspiration Pneumonia
• Tuberculosis
 History
• Recent diagnosis and treatment of
pneumonia
• Recent penetreting chest trauma or
diagfragmatic injury.
• Cough productive bloody sputum
• Fever, SOB
• Anorexia, weight loss
• Night sweat
• Pleuretic chest pain
 Physical examination
• Temperature elevated
• Tachypnea
• Rales
• Ronchi
• Egophony
• Decrease breath sound
• Dullness on percussion
 Investigations
• Lab test: FBC, sputum and blood
culture
• Chest X-ray.
• C-T scan.
• Ultrasonography
• Thoracentesis
 Thoracentesis
• Thoracentesis is a procedure that the
patient is given a local anesthetic, a
needle is inserted into the pleural
cavity through the back between the
ribs on the infected side, and a sample
of fluid is withdrawn.
• If the patient has empyema, there will
be leukocytosis, a high level of protein,
and a very low level of blood sugar.
 Treatment
• Empyema is treated using a combination of
medications and surgical techniques
• Treatment with medication involves
intravenously administering a two-week
course of antibiotics.
• It is important to give antibiotics as soon
as possible to prevent first-stage
empyema from processing to its later
stage.
• The antibiotics most commonly used are
penicillin and vancomycin.
 Surgical Treatment
• Surgical treatment of empyema has two goals:
drainage of the infected fluid and closing up of
the space left in the pleural cavity.
• In second-stage empyema, the surgeon will insert
a chest tube in the patient’s rib cage or remove
part of a rib (rib resection).
• In third-stage empyema, the surgeon may cut or
peel away the thick fibrous layer coating the
lung, a procedure which is called decortication.
• The doctor may use video-assisted thoracic
surgery (VATS) techniques to position the chest
tube or to perform a limited decortication.
 Thoracic Surgery
• General thoracic surgery deals specifically
with disorders of the lung and esophagus.
• Blunt chest trauma, reflux esophagitis,
esophageal Ca, lung transplantation, lung Ca,
and emphysema are just a few of the many
clinical indications for thoracic surgery.
• Patients who have blood-clotting problems,
and who have had previous standard
thoracic surgery may not be good
candidates for VATS.
 Thoracic Surgery
• VATS is a minimally invasive surgical
technique that uses a thoracoscope to
allow the surgeon to view the chest cavity.
• A lung is collapsed and 3-4 small or access
ports, are made to facilitate insertion of
the thoracoscope and surgical instruments.
• When the surgical procedure is complete,
the surgeon expands the lung and inserts a
chest tube in one of the incision sites.
 Complications
• Rupture into the lung;
BronchoPleural fistula
• Spread to the subcutaneous tissue;
Empyema Nessicitans.
• Septicaemia & septic shock.
THANK YOU

GOOD LUCK!!