Empyema


Empyema

Description, Causes and Risk Factors:

Empyema is an accumulation of pus in the space between the lung and the membrane that surrounds it (pleural space) that occurs when an infection spreads from the lungs. This pus contains white blood cells that fight infection (polymorphonuclear leukocytes) and blood proteins involved in clotting (fibrin). When pus builds up in the pleural space, it puts pressure on the lungs and results in shortness of breath and pain.

Empyema and parapneumonic effusion are well documented complications of community acquired bacterial pneumonias (CAP). Recent studies have shown that the incidence of empyema in CAP is on an increase and causes significant childhood morbidity.

Empyema

It may also result from an infection after chest surgery (postoperative infection), a traumatic penetrating chest injury, or a medical procedure that invades the chest such as thoracentesis or insertion of a chest tube. Pus from an abscess in the abdomen just beneath the lungs (subphrenic abscess) may also spread to the pleural space and result in empyema. Empyema can occur as a complication of many other conditions including septicemia, septic thrombophlebitis, spontaneous pneumothorax, mediastinitis, or esophageal rupture.

Pneumococcal infection remains the most isolated cause in developed countries while Staphylococcus aureus is the most common causative organism in developing world. The risk factors which predispose certain patients of CAP to develop empyema are not very clear and are still under investigation. Very few studies address these issues in children.

Despite the advances in the diagnostic facilities, and wide spread use of more effective antibiotics, and early referral, empyema is still one of the most serious chest surgical problems in children and especially in neonates.

Symptoms:

Symptoms may include:

    Fever and chills.

  • Dry cough.

  • Excessive sweating, especially night sweats.

  • General discomfort, uneasiness, or ill feeling (malaise).

  • Unintentional weight loss.

  • Chest pain, which worsens on deep inhalation (inspiration).

Diagnosis:

The health care provider may note abnormal findings, such as decreased breath sounds or a friction rub, when listening to the chest with a stethoscope (auscultation).

Tests may include the following:

    Chest x-ray.

  • CT scan of chest.

  • Thoracentesis.

  • Pleural fluid gram stain and culture.

Treatment:

The goal of treatment is to cure the infection and remove the collection of pus from the lung. Empyema is usually treated on an inpatient basis with intravenous antibiotics (IV antibiotics) for the underlying infection. Prompt drainage of the accumulated pus is important. Although removal of pus with a needle (thoracentesis) can provide immediate relief, fluid usually re-accumulates quickly. Insertion of a chest tube (thoracostomy) allows continuous drainage of fluid. The individual's breathing (respiratory) status is monitored closely so respiratory assistance can be provided, as needed. Pain medication (analgesics) may be prescribed, if needed. If the pleural fluid collections are separated into smaller areas because of fibrin deposition (loculated), a medication to break up the fibrin, such as urokinase, may be instilled into the chest cavity. A surgeon may need to manually open and drain the fluid pockets (decortication) if the lung does not expand properly.

An empyema may require many weeks to resolve. Once the underlying infection is controlled and the respiratory status is stable, individuals can be discharged from the hospital with a chest tube and drainage bag in place.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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