Difference between revisions of "Empyema"

(Diagnosis)
(Text replacement - "*CXR" to "*CXR")
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*Stages
 
*Stages
 
*#Exudative - Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
 
*#Exudative - Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
*#Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely
+
*#Fibrinopurulent - Loculations develop making resolution with 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
  
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*[[Tuberculosis]]
 
*[[Tuberculosis]]
 
*[[Pleural Effusion]]
 
*[[Pleural Effusion]]
*[[Wegener's granulomatosis]]
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*[[Granulomatosis with polyangiitis]] (wegener's)
 
*[[Pulmonary embolism]]
 
*[[Pulmonary embolism]]
  
==Diagnosis==
+
==Evaluation==
 
===Work Up===
 
===Work Up===
 
*CBC
 
*CBC
*CXR
+
*[[CXR]]
 
*[[Thoracentesis]]
 
*[[Thoracentesis]]
 
*Sputum Culture -- Acid Fast Bacilli (If TB suspected)
 
*Sputum Culture -- Acid Fast Bacilli (If TB suspected)
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*Blood Cultures
 
*Blood Cultures
  
===Evalucation===
+
===Evaluation===
 
*Aspiration of grossly purulent pleural fluid on [[thoracentesis]] and at least 1 of the following:<ref>http://emedicine.medscape.com/article/807499-overview</ref>
 
*Aspiration of grossly purulent pleural fluid on [[thoracentesis]] and at least 1 of the following:<ref>http://emedicine.medscape.com/article/807499-overview</ref>
 
**+ Gram stain or culture
 
**+ Gram stain or culture
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**LDH >1000 IU/mL
 
**LDH >1000 IU/mL
  
==Treatment==
+
==Management==
 
*Treat underlying disease
 
*Treat underlying disease
 
*O2 if [[Hypoxemia]]
 
*O2 if [[Hypoxemia]]
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*[[Antibiotics]]
 
*[[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 patient at risk for [[MRSA]]
  
 
{{Chest tube size table}}
 
{{Chest tube size table}}
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[[Category:ID]]
 
[[Category:ID]]
[[Category:Pulm]]
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[[Category:Pulmonary]]

Revision as of 08:03, 9 September 2016

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 with single chest tube drainage unlikely
    3. Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion

Causes

Clinical Features

Differential Diagnosis

Evaluation

Work Up

Evaluation

  • 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

Management

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