Empyema Thoracis

U15MD1080

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Outline
• Introduction
• Epidemiology
• Aetio-pathogenesis
• Clinical features
• Investigations
• Treatment
• Complications
• Prognosis
• Conclusion
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Introduction
• The pleura refer to the serous membranes that line the lungs and thoracic cavity.
They permit efficient and effortless respiration.

• The pleural cavity is a potential space between the visceral and parietal pleura.

• Empyema thoracis is a collection of purulent fluid in the pleural cavity.

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Epidemiology
• In the United States, the incidence of parapneumonic empyema is estimated to
be 6 cases per 100,000. In hospital morality in the adult population(over 65 years
of age) is 16.1%.

• Patients with HIV/AIDS are more likely to have pneumonia and in turn more likely
to develop empyema.

• A major problem in tropical Africa especially in children, as a result of inadequate

treatment of pneumonia.

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Aetio-pathogenesis
• Risk Factors:
• Age under 60years old
• Poor oral hygiene
• Disorders with predisposition to aspiration(Seizures, alcoholism,)
• IV drug abusers
• Diabetes mellitus
• Liver cirrhosis
• Other immunocompromised states(HIV infection, malignancy)
• Bacteriology
• Staphylococcus aureus
• Streptococcus spp
• Escherichia coli
• Pseudomonas aeruginosa
• Candida albicans
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Aetio-Pathogenesis..2

Source: Baja’s Principles and Practice of

surgery 5th Edition

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Aetio-Pathogenesis..3
• Can be divided into stages

• Exudative stage
• Fibrinopurulent and loculated stage
• Chronic Organizational stage

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Clinical Features
Clinical features differ, either acute or chronic
• Fever
• Cough
• Dyspnea
• Pleuritic Chest pain
• Weight loss
• Scoliosis
• Stony dull percussion
• Decreased breath sounds

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Investigations
• Imaging:
• Chest X-ray:
• Unilateral, markedly asymmetrical opacity with blunting of the costophrenic angle
• Lentiform opacity
• mediastinal shift to the opposite side, elevated dome of the diaphragm and scoliosis in chronic cases
• Ultrasound and CT scan have greater sensitivity for fluid detection and for determining the
extent and nature of the pleural infection
• Thoracentesis
• FBC + differentials
• Leukocytosis
• Lymphocytosis
• Anemia

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 Investigations..2

Fig: Plain Chest X-ray PA and Lateral, Empyema

thoracis Source: Radiopaedia.com
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Investigations..3

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Treatment
• Goals of therapy include:
• Eradication of the infection via antibiotics
• Pleural drainage using tube thoracostomy with or without intrapleural medications
• Video-assisted thoracoscopic surgery(VATS) or open thoracostomy and decortication for
chronic cases

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Complications
• Sepsis
• Septic shock
• Empyema necessitans
• Bronchopleural fistula
• Pneumothorax

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Prognosis
• It carries a poor prognosis if not treated early and aggressively at the time of
diagnosis

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Conclusion

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