Difference between revisions of "Empyema"

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*#Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely
 
*#Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely
 
*#Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion
 
*#Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion
 
==Presentation==
 
*Fever
 
*Shortness of breath
 
*Anorexia
 
*Night sweats
 
*Pleuritic chest pain
 
*Hemoptysis
 
*Recent dx and/or treatment of [[Pneumonia]]
 
*History of penetrating chest trauma or diaphragmatic injury<ref>Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6</ref>
 
  
 
===Causes===
 
===Causes===
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==Clinical Features==
 
==Clinical Features==
*Usually preceded by PNA
+
*[[Fever]]
**Suspect if symptoms of PNA do not resolve
+
*[[Shortness of breath]]
 +
*Anorexia
 +
*Night sweats
 +
*Pleuritic [[chest pain]]
 +
*[[Hemoptysis]]
 +
*Recent diagnosis and/or treatment for [[Pneumonia]]
 +
*History of penetrating chest trauma or diaphragmatic injury<ref>Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6</ref>
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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*[[Pulmonary embolism]]
 
*[[Pulmonary embolism]]
  
==Work Up==
+
==Diagnosis==
 +
===Work Up===
 
*CBC
 
*CBC
 
*CXR
 
*CXR
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==References==
 
==References==
<references/>
+
<references/>
  
 
[[Category:ID]]
 
[[Category:ID]]
 
[[Category:Pulm]]
 
[[Category:Pulm]]

Revision as of 18:06, 8 June 2015

Background

  • Pleural space infections with + Gram stain/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

Differential Diagnosis

Diagnosis

Work Up

Diagnosis

  • Aspiration of grossly purulent pleural fluid on thoracentesis and at least 1 of the following:[2]
    • + Gram stain or culture
    • WBC count > 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL)
    • Pleural fluid glucose <60
    • pH <7.2
    • LDH >1000 IU/mL

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

References

  1. Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6
  2. http://emedicine.medscape.com/article/807499-overview