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Thoracic empyema: Difference between revisions

Thoracic empyema (view source)

Revision as of 21:04, 18 March 2024

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(Created page with "'''Thoracic empyema''' or '''pleural empyema''' refers to accumulation of pus in the pleural cavity. The most common bacteria involved are streptococci and staphylococci. Mycobacteria are a rare cause. Development of thoracic empyema is a cause of treatment failure for pneumonia, and it should be considered in those cases where patients don’t get better on antibiotic treatment. == Etiology == Thoracic empyema can be primary (idiopathic) or secondary t...")
 
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== Diagnosis and evaluation ==
== Diagnosis and evaluation ==
Thoracic empyema is usually suspected when an [[x-ray]] is performed on a patient with suspected or known pneumonia. From there, [[ultrasound]] or [[CT]] may be used to visualise the pleural fluid and to guide [[thoracocentesis]]. Only thoracocentesis and analysis of the fluid can prove that the fluid is pus. The fluid should be [[Bacterial culture|cultured]] for bacteria.
All cases with suspected pneumonia should undergo routine [[chest radiography]] to confirm the diagnosis with the presence of consolidations. A pleural effusion (which is not know to be an empyema at this point) can be visible on the x-ray. From there, [[ultrasound]] or [[CT]] may be used to assess the pleural fluid further and to guide [[thoracocentesis]]. Only thoracocentesis and analysis of the fluid can prove that the fluid is an empyema. The fluid should be cultured for bacteria. Biochemical analysis can prove that the fluid is an empyema and not another form of effusion. The following findings of the fluid confirms that it is an empyema:
 
* The fluid is purulent
* pH < 7.20
* Elevated leukocyte count
* Decreased glucose level
* Elevated LDH level


== Treatment ==
== Treatment ==
Treatment involves drainage and antibiotics. Drain may be one-time (thoracocentesis) or continuous with a tube thoracostomy.
The infection will not improve unless there is source control, which in this case means drainage of the fluid. Treatment involves drainage and antibiotics. Drain may be one-time (thoracocentesis) or continuous with a tube thoracostomy.
<noinclude>[[Category:Pulmonology]]
<noinclude>
[[Category:Thoracic surgery]]</noinclude>
[[Category:Pulmonology]]
[[Category:Thoracic surgery]]
</noinclude>