Difference between revisions of "Empyema"

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

Revision as of 20:59, 13 May 2015

Background

  • Pleural space infections with positive Gram stain or culture OR parapneumonic effusions without pleural fluid sampling
  • 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)
  • Traumatic pneumothorax
    • 2012 study using 28-32 Fr tube just as good as 36-40 Fr tube. [1] This is reflected in the ATLS 2019 Guidelines: "ATLS ® -10 now recommends placement of a smaller 28F to 32F chest tube for any acute hemothorax that is visible on chest radiograph." [2]
  • Empyema
  • Bleeding (Hemothorax/hemopneumothorax)
  • Thick pus

See Also

Source

  • Tintinalli
  • Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
  • Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.