EMPYEMA THORACIS
• An empyemais a collection or gathering of pus within a naturally existing anatomical cavity. For example, pleural empyema is empyema of the pleural cavity. It must be differentiated from an abscess, which is a collection of pus in a newly formed cavity
• Epmyema thoracis is associated with high mortality ranging between 6% to 24%. • The incidence of empyema is increasing in both children and adults; the cause of this surge is unknown. • Most cases of empyema complicate communityor hospital-acquired pneumonia but a proportion results from iatrogenic causes or develops without pneumonia
Definition Accumulation of Pus in the Pleural cavity
Etiology • Lung diseases: Pneumonia (the most common cause) Lung abscess. • Subphrenic abscess. • Post traumatic. • Iatrogenic. • Post-operative. • Blood spread
Organisms The most common: • Staph.aureus .(90% of causes in infants & children) • Strept.pneuomonie. • H.influenzae
Pathological Stages • Acute (exudative) stage: Pleura fills with thin fluid that shows one or more of these criteria; Ph 1000 iu/dl Protein > 2.5 gm/dl Sp.gravity >1.018
Stages (cont.) • Fibrinopurulent stage: Thick, Opaque fluid with positive culture (pus) and Deposition of thin fibrin layer over the pleura. Progressive loculation and formation of pouches in the pleura
Stages (cont.) • Organizing Stage: Presence of very thick pus . Thick Inelaastic peel over both pleurae causing entrapment of the lung
Clinical stages • Acute stage : within the first 2 weeks of the onset. • Chronic Stage : after 2 weeks or with the formation of the thick peel and loculations