Difference between revisions of "Empyema"

(Treatment)
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***Takes several weeks to develop; "pleural peel" restricts lung expansion
 
***Takes several weeks to develop; "pleural peel" restricts lung expansion
  
==Causes==
+
===Causes===
#Pneumonia
+
*[[Pneumonia]]
#Complications of chest or abdominal trauma
+
*Complications of [[thoracic trauma|chest]] or [[abdominal trauma]]
#Esophageal perforation
+
*[[Esophageal perforation]]
#Extension from lung abscess
+
*Extension from lung abscess
#Osteomyelitis or other near pleural infections
+
*[[Osteomyelitis]] or other near pleural infections
#Hemothorax, chylothorax, or hydrothorax that becomes infected
+
*[[Hemothorax]], [[chylothorax]], or [[hydrothorax]] that becomes infected
  
==Diagnosis==
+
==Clinical Features==
 
*Usually preceded by PNA
 
*Usually preceded by PNA
 
**Suspect if symptoms of PNA do not resolve
 
**Suspect if symptoms of PNA do not resolve
*Diagnostic criteria
+
 
**Aspiration of purulent material on thoracentesis and at least 1 of the following:
+
==Differential Diagnosis==
***1. Positive Gram stain or culture
+
 
***2. Pleural fluid glucose <40
+
==Diagnosis==
***3. pH <7.1
+
*Aspiration of purulent material on [[thoracentesis]] and at least 1 of the following:
***4. LDH >1000
+
*#Positive Gram stain or culture
 +
*#Pleural fluid glucose <40
 +
*#pH <7.1
 +
*#LDH >1000
  
 
==Treatment==
 
==Treatment==
 
*Treat underlying disease
 
*Treat underlying disease
*Perform thoracentesis versus chest tube drainage if e/o respiratory distress
+
*Perform [[thoracentesis]] versus [[chest tube]] if evidence of respiratory distress
*Abx
+
*[[Antibiotics]]
**Piperacillin-tazobactam 3.375-4.5gm q6hr IV or imipenem 0.5-1gm q6hr
+
**[[Piperacillin-tazobactam]] 3.375-4.5gm q6hr IV or [[imipenem]] 0.5-1gm q6hr
**Consider adding [[vancomycin]] if pt at risk for MRSA
+
**Consider adding [[vancomycin]] if pt at risk for [[MRSA]]
 +
 
 +
{{Chest tube size table}}
  
 
==See Also==
 
==See Also==
*[[Pleural Effusion]]
+
*[[Pleural effusion]]
  
 
==Source==
 
==Source==

Revision as of 20:58, 13 May 2015

Background

  • Pleural space infections with positive Gram stain or culture OR parapneumonic effusions without pleural fluid sampling
  • 3 stages
    • 1. Exudative
      • Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
    • 2. Fibrinopurulent
      • Loculations develop making resolution w/ single chest tube drainage unlikely
    • 3. Organizational
      • Takes several weeks to develop; "pleural peel" restricts lung expansion

Causes

Clinical Features

  • Usually preceded by PNA
    • Suspect if symptoms of PNA do not resolve

Differential Diagnosis

Diagnosis

  • Aspiration of purulent material on thoracentesis and at least 1 of the following:
    1. Positive Gram stain or culture
    2. Pleural fluid glucose <40
    3. pH <7.1
    4. LDH >1000

Treatment

Adult Chest Tube Sizes

Chest Tube Size Type of Patient Underlying Causes
Small (8-14 Fr)
  • Alveolar-pleural fistulae (small air leak)
  • Iatrogenic air
Medium (20-28 Fr)
  • Bronchial-pleural fistulae (large air leak)
  • Malignant fluid
Large (36-40 Fr)
  • Bleeding (Hemothorax/hemopneumothorax)
  • Thick pus

See Also

Source

  • Tintinalli