Empyema

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**Empyema**
*Classification & external resources*
ICD-10	J 86.
ICD-9	510

An empyema is a collection of pus within a natural body cavity. It must be differentiated from an abscess, which is a collection of pus in a newly formed capsule rather than a pre-existing cavity.

In humans, the pleural space surrounding the lungs is most commonly affected. This particular condition is called pyothorax and is usually caused by a bacterial infection of the lungs (pneumonia). Other common empyemas include appendicitis and pyometra.

1 Symptoms
2 Diagnosis
3 Treatment
4 External links

[edit] Symptoms

Typical symptoms are just about the same as tuberculosis which includes: fever (which may be spiking), chest pain, cough, sweating and shortness of breath.

Clubbing is present and a toxic look on the patients face. There is a dull percussion note and reduced breath sounds on the affected side of the chest. Chest x-ray shows a pleural effusion, often with a lateral bulge and pleural thickening. Ultrasound confirms the size and location of the pocket of pus and the presence of fibrin aggregates.There are 3 stages:Exudative, fibrinopurulent and organizing. In the exudative stage, the pus accumulates. This is followed by the fibrinopurulent stage in which there is loculation of the pleural fluid (the creation of grapelike pus pockets). In the final organizing stage there is the potential for lung entrapment by scarring. If it makes it to the final stage and scarring occurs there is a good chance of pulmonary fibrosis and other conditions that will happen in years to come, such as right sided heart failure (cor pulmonale). This is do to the high pulmonary pressures due to the scarring and the treatment is most likely a single lung transplant. The only drug that might have any effect is prednisone, but the use of prednisone is only temporary.

[edit] Diagnosis

Diagnosis is confirmed by thoracentesis,xray and ct scan. Frank pus may be aspirated from the pleural space. The pleural fluid has a low pH,and the blood has a high white blood cell count usually above 20,000. As would extensive blood testing and culturing to determine the condition.Also Arterial blood gases to determine the PH,Co2 and o2 levels.Another test to confirm empyema is a pleural tap.(removing 3-4 pieces of 1 to 2cm of the pleura).

[edit] Treatment

A chest tube is inserted to drain the pus from the pleural space, using ultrasound scan guidance. Intravenous antibiotics are given. If this is insufficient, surgical decortication of the pleura may be required.And 02 therapy.

Some evidence suggests that intrapleural fibrinolytic drugs may be useful, especially in children.Also supplemental oxygen via nasal cannula is usually a good idea since the o2 sats will be near 93% or below.If below 90% a venti mask or non-re-breather for higher doses of oxygen is recommended. This is usually when it's in the 3rd stage.