Empyema of the Pleura

Pleural empyema: causes, symptoms and treatment

Pleural empyema, also known as purulent pleurisy or pyothorax, is a serious complication of infectious lung diseases. It is characterized by the accumulation of pus in the pleural cavity, which leads to compression of the lung tissue and can lead to various complications. In this article we will look at the causes, symptoms and treatment of pleural empyema.

Causes

Pleural empyema can be caused by various reasons, which may be direct or indirect. The direct route of infection into the pleural cavity includes lung injury, chest wall injury, esophageal rupture (post-traumatic empyema), pneumonia, tuberculosis, lung abscess or gangrene, bronchiectasis, pulmonary resection, pneumothorax. The most common are para- and metapneumonic empyemas.

The indirect route of infection includes subdiaphragmatic abscess, acute pancreatitis, liver abscesses, inflammation of soft tissues and the bone frame of the chest wall. The causative agents of pleural empyema can be various microorganisms, including staphylococci, pneumococci, facultative and obligate anaerobes (Pseudomonas aeruginosa).

Symptoms

The clinical picture of pleural empyema may be masked by symptoms of pneumonia, so diagnosing this disease can be difficult. However, you should pay attention to symptoms such as the appearance of pleural friction rub and pain, which may disappear with continued accumulation of fluid in the pleural cavity. Shortening of the percussion sound, disappearance of respiratory sounds and weakened vocal tremors are also determined.

With metapneumonic empyema, the signs of pneumonia are more easily recognized than with post-pneumonic empyema, obscured by current pneumonia. The general condition of the patient progressively worsens as a result of purulent-resorptive fever: weakness, loss of appetite, weight loss, hectic temperature, rapid pulse, high leukocytosis with a shift of the formula to the left, hypo- and disproteinemia.

Diagnostics

To diagnose pleural empyema, X-ray and ultrasound examination of the chest, as well as computed tomography, are used. Radiological signs of pleural empyema include the presence of fluid in the pleural cavity, shortening of the percussion sound, disappearance of respiratory sounds and weakened vocal tremors. Ultrasound may be helpful in determining the amount of fluid collected and its nature. Computed tomography can be used to determine the exact location of the purulent cavity and its relationship to surrounding tissues.

Treatment

Treatment of pleural empyema includes antibiotic therapy and drainage of the pleural cavity. Antibiotic therapy should be aimed at destroying the causative agent of the disease as soon as it is identified. The choice of antibiotic depends on the type of pathogen and sensitivity to antibiotics. Drainage of the pleural cavity can be performed in a variety of ways, including thoracotomy, thoracoscopy, or insertion of a tube under ultrasound or x-ray guidance.

In some cases, surgery may be required to remove a purulent cavity or dissect adhesions in the pleural cavity. Pleural empyema is a serious condition and treatment must be immediate and adequate. If treatment is delayed or treated incorrectly, serious complications such as sepsis, pericardial empyema, or mediastinal empyema may occur.

Pleural empyema is a condition characterized by the presence of pus in the pleural cavity, which can lead to serious health complications. This article examines the causes and symptoms of pleural empyema, as well as methods of treatment and prevention of this disease.

What is empyema? Empyema (from the Greek “empiema” - “filling”) is the presence of pus that accumulates in the cavity, after which the cavity ceases to perform its functions. The cavity turns into a reservoir accumulating pus. Pus is a product of the immune system fighting infection. When the immune system fails to cope and the infection penetrates deep into the body, it goes along with it.

Empyema of the pleural cavity is an acute inflammation accompanied by the accumulation of pus in the pleural cavity. Empyema inflammation usually occurs as a complication of infectious diseases - pneumonia, bronchopneumonia, severe angina and other acute diseases. Abundant accumulation of purulent fluid in the pleural space can lead to the development of bacterial peritonitis and sepsis.

Clinical signs of pleural empyema are cough, general weakness, loss of appetite, and increased body temperature. Leukocytosis, bacterial pleural effusion, and an increase in ESR can be detected in peripheral blood. When performing a chest x-ray, intense darkening is detected in the area of ​​​​the pleural lesion and a displacement of the mediastinal organs to the healthy side.

Pleural empyema must be treated in a timely manner, since delayed treatment can lead to the formation of adhesions of the pleural layers, disruption of the respiratory function of the lungs, and the development of pleural adhesions. Antibacterial therapy, sputum analysis, correction of the patient’s diet and general condition are carried out in order to eliminate the causes contributing to the occurrence of empyema and subsequent rehabilitation of the body. The majority of patients require surgical intervention aimed at opening the purulent contents, removing pus, draining air from the cavity and draining the wound or installing drainage. Often they use the method of applying bioglue to the wound, introducing antiseptic drugs through drainage, followed by prescribing physiotherapeutic treatment.

The prognosis of empyema depends on the cause of the disease, the adequacy of treatment and the presence of complications. If the disease is not treated, serious consequences such as sepsis or spontaneous pneumothorax can occur. Therefore, it is very important to consult a doctor promptly if symptoms of empyema appear in order to avoid negative consequences.