Difference between revisions of "Empyema"

(Text replacement - "*CXR" to "*CXR")
 
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*Complications of [[thoracic trauma|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
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*[[Hemoptysis]]
 
*[[Hemoptysis]]
 
*Recent diagnosis and/or treatment for [[Pneumonia]]
 
*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>
+
*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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==Management==
 
==Management==
 
*Treat underlying disease
 
*Treat underlying disease
*O2 if [[Hypoxemia]]
+
*[[O2]] if [[Hypoxemia]]
 
*Perform [[thoracentesis]] vs. [[chest tube]] if evidence of respiratory distress
 
*Perform [[thoracentesis]] vs. [[chest tube]] if evidence of respiratory distress
 
**May need Video-Assisted Thoracic surgery (VATS)
 
**May need Video-Assisted Thoracic surgery (VATS)

Latest revision as of 15:31, 12 October 2019

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)
  • Traumatic pneumothorax
    • 2012 study using 28-32 Fr tube just as good as 36-40 Fr tube. [3] 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." [4]
  • Empyema
  • 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
  3. Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
  4. Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.