Pleural Empyema Flashcards
What is pleural empyema?
Accumulation of pus in the pleural cavity
This condition often arises as a complication of pneumonia.
What is the most common etiology of pleural empyema?
Pneumonia
Other causes can include infected hemothorax, ruptured lung abscess, esophageal tear, and thoracic trauma.
List less common causes of pleural empyema.
- Infected hemothorax
- Ruptured lung abscess
- Esophageal tear
- Thoracic trauma
These causes can lead to the accumulation of pus in the pleural cavity.
What is Stage I of pleural empyema classification?
Exudative: accumulation of fluid and pus
This stage marks the initial phase of pleural empyema.
What occurs in Stage II of pleural empyema?
Fibrinopurulent: aggregation of fibrin deposits that form septations and pockets
This stage indicates a progression in the disease process.
Describe Stage III of pleural empyema.
Organizing: formation of thick fibrous peel on pleural surface that restricts lung movement
This stage can significantly impact respiratory function.
What are common clinical features of pleural empyema?
- Fever
- Chills
- Cough
- Chest discomfort
These symptoms can help in the clinical diagnosis of the condition.
What is pleural effusion?
Accumulation of fluid in the pleural space
Can be classified as exudative or transudative based on the cause
What does the ‘split pleura sign’ indicate?
Thickening of visceral and parietal pleura
Often seen in empyema cases
What are the characteristics of exudative effusion?
Grossly purulent appearance, positive Gram stain and bacterial culture, pH < 7.2, low glucose < 30-60 mg/dL
Indicates infection or malignancy
What is the first-line treatment for community-acquired pleural empyema?
Combination therapy with a parenteral second- or third-generation cephalosporin plus anaerobic coverage
Examples include ceftriaxone with metronidazole or clindamycin
What should be added to the treatment of hospital-acquired pleural empyema?
MRSA and pseudomonal coverage
Use vancomycin plus cefepime and metronidazole, piperacillin-tazobactam, or meropenem
What is the recommended treatment for Stage I empyema?
Chest tube (thoracostomy) and consider intrapleural administration of fibrinolytic agents
Focuses on fluid removal
What is the second-line treatment for Stage II or mixed Stage II/III empyema?
VATS (Video-Assisted Thoracoscopic Surgery) debridement if chest-tube drainage is ineffective
First-line treatment remains chest tube drainage
True or False: Aminoglycoside antibiotics are recommended for pleural empyema treatment.
False
Poor pleural bioavailability makes them ineffective
Fill in the blank: The treatment for Stage III empyema includes _______.
VATS debridement and pleurectomy with lung decortication via open thoracotomy
Involves more invasive procedures to manage advanced disease
What is the role of empiric antibiotic therapy in pleural empyema treatment?
All patients should receive empiric antibiotics adjusted to their needs, local resistance patterns, and institutional guidelines
Essential for managing infections effectively
Management of empyema ?
What is pleural effusion?
Accumulation of fluid in the pleural cavity.
This can be categorized into different types based on the nature of the fluid.
What is the difference between parapneumonic effusion and empyema?
Parapneumonic effusion is an accumulation of exudative fluid; empyema is an accumulation of pus in the pleural cavity.
Both conditions are related to pneumonia.
What is the most common etiology of parapneumonic effusion?
Pneumonia.
Other causes can include infected hemothorax, ruptured lung abscess, esophageal tear, and thoracic trauma.
What characterizes uncomplicated parapneumonic effusion?
Exudative effusion without direct bacterial invasion.
It is often associated with mild symptoms.
What characterizes complicated parapneumonic effusion?
Exudative effusion with bacterial invasion
This condition may lead to further complications if untreated.\
Empyema = bacterial colonisation
What are the clinical features of pleural empyema?
- Fever
- Chills
- Cough
- Chest discomfort
These symptoms indicate a more severe infection.
What imaging techniques are used to diagnose parapneumonic effusion?
- Chest x-ray
Imaging helps to visualize the fluid accumulation.
What is the pH of pleural fluid in uncomplicated parapneumonic effusion?
pH > 7.2.
Indicates less severe infection compared to complicated cases.
What is the pH of pleural fluid in complicated parapneumonic effusion or empyema?
pH < 7.2.
This indicates a more severe infection with potential bacterial activity.
What is the glucose level in pleural fluid for uncomplicated parapneumonic effusion?
Normal or low.
Glucose levels can help differentiate between types of effusion.
What is the glucose level in pleural fluid for complicated parapneumonic effusion or empyema?
Low.
Low glucose levels are indicative of infection and inflammatory processes.
What is a common treatment for parapneumonic effusion?
Systemic antibiotic treatment.
This helps prevent progression to complicated effusion and empyema.
What procedure is often performed for empyema treatment?
Chest tube (thoracostomy).
This allows for drainage of pus and fluid from the pleural cavity.
