Topic 15 of 74 in the MU Sofia syllabus for Surgery (Medicine, Year 5). The free AceMed note covers it in 9 sections, about 439 words (6 min of reading), with 16 flashcards.
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TOPIC 15
Pleural empyema (pyothorax)
DEFINITION AND STAGES
AETIOLOGY AND MICROBIOLOGY
CLINICAL FEATURES
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
COMPLICATIONS AND FOLLOW-UP
DEFINITION AND STAGES
Pleural empyema is pus within the pleural cavity, usually arising from pneumonia (parapneumonic infection), but it may follow thoracic surgery, trauma, oesophageal rupture or subdiaphragmatic infection.
The evolution is commonly described in three stages: exudative (thin infected fluid), fibrinopurulent (loculations and fibrin deposition) and organising (fibrous peel restricting lung expansion).
Early recognition and drainage reduce the risk of chronic trapped lung.
AETIOLOGY AND MICROBIOLOGY
Common organisms include Streptococcus species, Staphylococcus aureus, anaerobes and Gram-negative organisms; microbiology varies with community versus hospital acquisition, aspiration risk and prior antibiotics.
Risk factors include pneumonia, diabetes, immunosuppression, alcohol misuse, aspiration, poor dentition, thoracic procedures and oesophageal pathology.
Infection causes neutrophilic inflammation, fibrin deposition, septation and pleural thickening.
The organising phase can prevent re-expansion and cause restrictive impairment.
CLINICAL FEATURES
Fever, pleuritic pain, cough, dyspnoea, malaise and weight loss are common.
Examination may reveal reduced chest expansion, dullness to percussion, decreased breath sounds and signs of sepsis.
A persistent fever or failure to improve after pneumonia treatment should raise suspicion.
In advanced disease, there may be respiratory failure, septic shock or a bronchopleural fistula.
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