Empyema

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Empyema

• Thoracic department

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Definition

• Pleural empyema is an accumulation of pus in the
  pleural space

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Pathogenesis

• Pneumonia(viral,bacterial,tuberculosis,mycotic)
• lung abscess
• trauma
• postoperative
• extension of subphrenic abscess
• spontaneous pneumothorax
• generalized sepsis

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acute empyema
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Clinical presentation and diagnosis

• High fever,tachypneic,tachycardiac,chest pain,
  increase of WBC
• decreased respiratory excursion,pain on
  percussion
• chest film
• ultrasound and CT scanning
• thoracentesis

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Management

• Antibiotic therapy
• adequate drainage and reexpanding of lung

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Chronic enpyema

• Chronic enpyema begins approximately 6 weeks
  after the onset of the acute illness.

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Pathogenesis

• Delay in seeking medical attention
• Inadequate antibiotic therapy during the acute
  phrase
• persistent conservative management with
  inadequate drainage
• the presence of an endobronchial or intrapleural
  foreign body

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• Infection of a postresectional space after a
  segmentectomy or lobectomy
• a chronic pulmonary infectionsuch as tuberculosis
• interstitial pulmonary disease that prevents
  reexpansion of the lung to obliterate the pleural
  space

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Management

• Tube thoracostomy
• open drainge
• myoplasty and decortication
• thoracoplasty