Background
- Pleural space infections with + Gram stain/culture OR parapneumonic effusions without pleural fluid sampling
- Stages
- 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
- 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[1]
Causes
Clinical Features
- Usually preceded by PNA
- Suspect if symptoms of PNA do not resolve
Differential 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
Chest Tube Size
|
Type of Patient
|
Underlying Causes
|
Small (8-14 Fr) |
|
- Alveolar-pleural fistulae (small air leak)
- Iatrogenic air
|
Medium (20-28 Fr) |
|
- Trauma/bleeding (hemothorax/hemopneumothorax)
- Bronchial-pleural fistulae (large air leak)
- Malignant fluid
|
Large (36-40 Fr) |
|
|
See Also
References
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