empyema and pleural effusion Flashcards
what is empyema?
it’s a collection of pus in the pleural space, usually after pneumonia
what is the most common causative organism of empyema?
streptococcus pneumoniae
what are 2 types of pleural effusion?
transudate
exudate
what are the 4 presentations of emypema?
c+b , pcp, p+r, rb+e
- cough and breathlessness
- pleuritic chest pain
- prolong and recurrent fever after pneumonia treatment
- reduced breathing and expansion
what is pleural effusion?
it is a collection of fluid in pleural space due to production and absorption imbalance
what are the 3 presentations of pleural effusion?
b, pcp, rb
- breathlessness
- pleuritic chest pain
- reduced breathing
what is transudate pleural effusion?
- non-inflammatory fluid that shifts in pleural space
- low protein content <3g/dL (<35g/L)
what is exudate pleural effusion?
- accumulation of inflammatory fluid in pleural space
- high protein content >3g/dL (>35g/l)
what are the 4 causes of transudate pleural effusion?
hf, h, lc, ns
- heart failure
- hypoalbuminaemia
- liver cirrhosis (scarring)
- nephrotic syndrome
what are 4 causes of exudate pleural effusion?
m, p, p, pe
- malignancy
- pancreatitis
- pneumonia
- pulmonary embolism
what do you look for in the blood tests?
-full blood count
raised white blood cells
raised inflammatory marker
c - reactive protein
what is the gold standard?
thoracic ultrasound and pleural fluid aspirate
what will you find in a CT scan of the thorax?
empyema shows thickened pleura compared to effusion
What does chest x ray show?
complex effusion
what does effusion and emypema aspirate analysis do?
determines pH, fluid type and casue of effusion
what are the results for the effusion and emypema?
simple parapneumonic effusion
pH >7.2
complicated parapneumonic effusion pH <7.2
empyema thoracis
frank pus and positive bacterial culture
what does the lights criteria do?
differentiates between transudate and exudate pleural effusion
what is the lights criteria for exudative pleural effusion?
effusion protein/ serum protein ratio >0.5
effusion LDH/ serum LDH ratio >0.6
effusion LDH level > 2/3 the upper limit of the lab’s reference rage of serum LDH
what is the treatment for simple parapneumonic effusion pH>7.2?
- treat the underlying cause
- oral antibiotics
what is the treatment for complicated parapneumonic effusion pH <7.2?
if thickened pleura on CT scan or positive culture
- treat the underlying cause
- IV antibiotics
- chest drainage
what is the treatment for empyema?
- antibiotics for 2-6 weeks
- chest drain insertion if fluid pH <7.2
- if there is NO improvement: VATS
What are the indications of chest drainage for parapneumonic effusion?
low pH<7.2
frank pus
positive bacterial culture
severely impacted breathing
