| Pleural empyema | |
|---|---|
| Other names | Pyothorax, purulent pleuritis, lung empyema, thoracic empyema |
 | |
| CT chest showing large right sided hydro-pneumothorax from pleural empyema. Arrows A: air, B: fluid | |
| Specialty | Thoracic surgery[1] |
| Symptoms | Fever, chest pain with breathing in, cough, shortness of breath[1][2] |
| Complications | Fibrothorax, respiratory distress[1] |
| Causes | Often bacterial[1] |
| Risk factors | Pneumonia, esophageal rupture, chest injury, chest surgery, diabetes[3][1] |
| Diagnostic method | Medical imaging, thoracentesis[1] |
| Differential diagnosis | Pneumonia, hemothorax, heart failure, pulmonary infarction[1][2] |
| Treatment | Antibiotics, drainage[1] |
| Frequency | Relatively common[1] |
Pleural empyema is a collection of pus in the space around the lungs (pleural cavity).[3] Symptoms may include cough, fever, shortness of breath, sputum production, and pleuritic chest pain.[1][2] Complications may include fibrothorax or respiratory distress.[1] It is a type of pleural effusion.[1]
It most commonly occurs as a complication of pneumonia.[1] Other causes include esophageal rupture, chest injury, and chest surgery.[3][1] Risk factors include diabetes and alcoholism.[1] The underlying mechanism most commonly involves a bacterial infection with Streptococcus or Staphylococcus.[1] Diagnosis is generally based on medical imaging followed by thoracentesis.[1]
Treatment is generally a combination of antibiotics and drainage.[1] Antibiotics may include a combination of ceftriaxone and metronidazole for 2 to 6 weeks.[1] If MRSA is a concern vancomycin may be added.[1] A chest tube or surgery may be used for drainage.[1] Despite treatment up to 30% of people require further surgery or die within a year.[1] In the United States about 32,000 cases occur per year.[1] It has been described since the time of Hippocrates.[2]
References edit
- ^ a b c d e f g h i j k l m n o p q r s t u v w Garvia, V; Paul, M (January 2020). "Empyema". PMID 29083780.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b c d Iguina, MM; Danckers, M (January 2020). "Thoracic Empyema". PMID 31334999.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b c Redden MD, Chin TY, van Driel ML (March 2017). "Surgical versus non-surgical management for pleural empyema". Cochrane Database Syst Rev. 3: CD010651. doi:10.1002/14651858.CD010651.pub2. ISSN 1469-493X. PMC 6464687. PMID 28304084.