Purulent pleurisy - pleural empyema

Purulent pleurisy - pleural empyema

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Purulent pleurisy and pleural empyema consists of the accumulation of pus in the pleural cavity. Maybe whatever space generalized purulent pleural effusion, or occupy a limited area thereof, located pleural empyema.
Most commonly associated with pleurisy purulent pleurisy parapneumonica. There are three stages of the disease: exudative, fibropurulenta and organization. In stage exuding pus accumulates. It is followed by stage are created fibrinopurulent pus pockets and organizational phase sclerosis pleural space may lead to lung incarceration.
Important clinical manifestations vary from purulent pleurisy accidental cardiovascular disease prior to malignant or inflammatory disease symptoms. Purulent pleurisy symptoms can vary in intensity. Typical symptoms include cough, fever, chest pain, sweating and shortness of breath. Digital Hipocratismul may be present in cases of chronic nature. The noise reduction detects percussion of the affected lung to the chest. Other diagnoses include the tools CBC, chest radiography, CT scan and ultrasound.
Diagnosis is confirmed by thoracentesis, aspiration of frank pus or cloudy fluid in the pleural space. Pleural fluid shows typical leukocytosis, infectious organisms, and increased lacticdehidrogenaza acid pH.
Requires definitive treatment for pleurisy purulent pleural fluid drainage infected. It will insert a chest tube by ultrasound guidance. Intravenous antibiotics are important. Surgical debridement may be required by techniques toracoscopice pleural space, but if chronic disease is limited thoracotomy may be required to fully drain fluid and remove purulent exudate in the lung and the chest wall.
Occasionally a full thoracotomy, decortication and pleurectomie required. Rarely require some portions of the lung resection. Chest tubes tend to clog. To combat this problem with holes large tube is placed or more tubes. Blocking the tubes can lead to accumulation of pus and worsening of clinical presentation, organ failure and even death.
Pleural Anatomy: Serous pleural lining the lung, ribs and intercostal spaces, diaphragm and mediastinal organs. Normally there is no real space between the visceral pleura and parietal pleura, which is virtual. Real becomes virtual air accumulation, blood, fluid tanks and aseptic fluid-benign or malignant pleurisy. May be non tubercular pleurisy purulent, tuberculous or mixed.
Pathophysiology of purulent pleurisy: Pleurisy is a common feature in patients with pneumonia. Over 45% of patients with bacterial pneumonia and 60% of those with pneumococcal pneumonia develop pleural parapneumonica. While antibiotic treatment leads to resolution in most patients develop some fibrinous reaction to this frank pus in the most severe cases.
Purulent pleurisy is divided into three broad categories depending on the characteristics of the liquid, which reflects the severity and natural history of pleurisy. Pleurisy parapneumonica uncomplicated: the exudative form, reflecting the predominantly neutrophilic interstitial fluid passage increased as a result of inflammation associated with pneumonia. The fluid may be cloudy or clear with no body in the Gram stain or culture. Be resolved with appropriate antibiotic treatment of pneumonia. Parapneumonice pleurisy complicated: These occur as a result of bacterial invasion into the pleural space, leading to increased number of neutrophils, decreased glicopleuriei acidosis and increased pleural lactic dehydrogenase. These pleurisy are usually sterile because bacteria are rapidly cleared di pleural space. The fluid is cloudy and is classified as complicated as they require drainage for resolution. Thoracic empyema: It develops as frank pus accumulation in the pleural space. Laboratory studies indicate that preexisting pleural fluid is necessary for the development of empyema empyema is not observed because after direct inoculation into a dry pleural space. Pus is seen after toracenteza or pleural space drainage procedure and is characterized as a thick, viscous and opaque.
Etiology pleural empyema: Primary microbial pathogen rarely affects the seeding by pleural serous marrow from a primary septic focus at distance (osteomyelitis, boil). Way marrow is challenged by some doctors who believe that indeed there may be a septic inoculation, but not in the pleura but in lung parenchyma. After lung abscess subpleurale insamintarii appear from the side who are seeded serous effusions.
Primitive suppurative process may be located in 50% of cases: -Lung -Mediatin Chest-wall -Spine Subfrenic-space.
Purulent pleurisy Topographically localized di can be: -Mediastinal pleurisy purulent, purulent collection is situated between the lung and mediastinal pleura Diaphragmatic pleurisy purulent-is between the lung and diaphragm dome -Purulent pleural fissure, the collection is large or small fissure in the right or the left fissure is bordered by the pulmonary lobes Apical-purulent pleural effusion, pleural encystation takes place between the dome and the apex of the lung.
The most common cause of pneumonia and empyema is a lung abscess. Other pulmonary causes can be: bronchiectasis suppurated, hydatid cyst effusion, lung cancer with effusion. Practically any primitive or secondary infection may complicate pulmonary topography with purulent pleurisy.
Pathogenic bacterial agent may pass into the pleural space via lymphatics, or by breaking through microperforations franca of lung collection. These pathogenic mechanisms to meet the aims and empyema due to a septic process mediastinal: adena effusion or acute mediastinitis in perforation of the esophagus by foreign body or iatrogenic (esophagoscopy, esophageal dilations for postcausitica esophagitis or peptic stenosis) or spontaneous rupture of the esophagus (Boerhave syndrome).
A process or rib osteomyelitis in the spine can be opened in the pleural cavity. Bottom of the lymphatic current subfrenic floor to explain the appearance of chest pleural exudates which most often turns subfrenic empyema in case of abscess, paracolic abscess, liver abscess, splenic abscess. May occur and a solution of continuity, a direct fistulization of the abscess in the pleural cavity resulting subfreno-pleural fistula or Bilio-pleural fistula.
Direct contamination of serous effusion is achieved in 40% of cases by minor surgical interventions (pleural puncture, puncture, pleural biopsy, pleurotomie) or after major surgery (lung resection, esophageal resection, esophageal diverticulotomii).
Posttraumatic pleural empyema: pleural space is vulnerable agent directly contaminates and foreign material and infection involved at this level is grafted on a hemotorax coagulated, which is a favorable environment for microbial proliferation. Superinfection of purulent tuberculous pleurisy is common resulting in a suppurative process Joint effusion.
Evolutionary stage in purulent pleurisy (pleural empyema) After insamintarii seoasei pleural septic inflammatory process occurs, characterized by the production of pleural exudate that turns foul, fibrin deposition, the hipervascularizatie, thickening of the visceral and parietal pleura, the progression of the underlying inflammatory lung and the chest wall penetration of neoformation vessels and fibroblasts in the thickened pleura. These injuries occur sequentially over a period of 3-4 weeks is divided into three stages:
Exudative Stage I: It causes inflammation of serous effusion, followed by the appearance of a pleural exudate Filante. Fibrin deposits occur and initiates fibroblast proliferation and angioblastica. Pleural fluid is sterile, polymorphonuclear occur in small numbers, pH and glicopleuria normal.
Fibrin-purulent stage II: Increases the pleural exudate becomes tulv = bure or frankly purulent, increased fibrin deposits, serous effusion lung is thickened but is still mobile, angioblastica proliferate. In pleural fluid increase the number of leukocytes exceeded 1500/mm3, proteinopleuria reaches more than 3 g%, pH drops below 7 glicopleuria is below 50 mg% and LDH 1000 IU% o.
Stage III of organization: Serous effusion is thickened up to 2-3 cm. bag is fastened pleural, lung is collapsed, the diaphragm is fixed, and the ribs are tringhiularizeaza narrow intercostal spaces. Fibroblast proliferation is intense and collagen formation is maximum. Pus is thick and empyema bag can not be dissolved only by surgery. Chronic phase is completed in 3-4 weeks.