empyema

Question 1

what is an empyema

Answer 1

purulent fluid collection in the pleural space

Question 2

what causes empyema

Answer 2

most are a complication of pneumonia

remainder are primary (can be idiopathic or iatrogenic)

Question 3

what are the risk factors of empyema

Answer 3

immunodeficiency
immunosuppression
abnormal innate immunological defence
repeated insult e.g. aspiration

Question 4

what are the stages of development of an empyema

Answer 4

simple pleural effusion -> complicated pleural effusion -> empyema

Question 5

describe the clinical presentation of an empyema

Answer 5

slow to resolve pneumonia (pt may recover then spike a temp)

may be signs of a pleural effusion on examination

Question 6

what investigations are used for empyema

Answer 6

CXR - fluid level
USS - to confirm a collection of fluid, may be used for thoracocentesis - will be pus
CT - not routinely used but can be used to differentiate between empyema and abscess

Question 7

outline the management for empyema

Answer 7

initially - broad spectrum antibiotics IV (amoxicillin and metronidazole)

oral antibiotics once cultures come back - direct to cultured bacteria. usually 5 weeks of co-amoxiclav

chest drain - 5th intercostal space, mid-axillary line (safe triangle)