What is pleural empyema?
Pleural empyema is a collection of pus in the cavity located between the visceral pleura and the parietal pleura. It is a specific and common type of empyema.
- Phases of pleural empyema
- Exudative: sterile pleural fluid accumulates related to increased capillary permeability due to the release of different cytokines.
- Fibrinopurulent: bacterial invasion of the pleural space produces endothelial damage, which leads to a decrease in the fibrinolytic response and fibrin deposition on both pleural surfaces, with the possibility of loculation.
- Organizational: various growth factors appear, such as fibroblasts, platelet-derived growth factor and transforming growth factor beta. Finally, in the final phase, fibrin deposition and later, collagenous fibrous tissue will appear. These three phases are carried out sequentially and progressively.
Causes of pleural empyema
Pleural empyema is caused by infection and contains a collection of pus in the pleural space. The infected fluid accumulates, usually two to four liters but can be greater if pressure is exerted on the lungs causing pain and shortness of breath. Other pulmonary causes include ruptured lung abscess, bronchiectasis, pulmonary infarction, spontaneous pneumothorax with persistent bronchopleural fistula, hydatid cyst, pulmonary tuberculosis….
The doctor will study each situation and prescribe the most appropriate treatment.
Risk factors for pleural empyema
Risk factors for pleural empyema include recent pulmonary diseases including: bacterial pneumonia, lung abscess, thoracic surgery, trauma or injury to the thorax. Another risk factor that rarely occurs is the introduction of a needle through the chest wall to drain fluid from the pleural space. This pathology can cause vomiting cough. Other risk factors include diabetes, chronic steroid use, immunosuppression, gastroesophageal reflux, history of bronchoaspiration, smoking or alcoholism.
Prognosis of pleural empyema
The manifestation of pleural empyema in a patient with parapneumonic effusion and empyema caused by aerobic germs is the same as in patients with bacterial pneumonia without effusion. If the fever lasts more than 48 hours after starting antibiotic treatment. In addition, the diagnosis of parapneumonic effusion should be made at the time of the patient’s first evaluation. There is a possibility that a pneumonia may develop an associated pleural effusion if the previous duration of symptoms is prolonged. Dyspnea on exertion or at rest and signs of respiratory distress may occur in cases where the amount of fluid is abundant.
Diagnosis of pleural empyema
The diagnosis of pleural empyema can be made by performing a thoracentesis. This is a test that aspirates the pus lodged in the pleural space. The evidence acquired is then analyzed in the microbiology laboratory. Another method is through auscultation with which a decrease in lung sounds can be identified. The diagnosis can be confirmed by chest X-ray, ultrasound, CT scan and pleural fluid analysis.
Treatment of pleural empyema
One of the effective treatments for pleural empyema is the drainage of the infected pleural fluid or pus, through the insertion of a pleural tube, with the aid of ultrasound guidance. Intravenous antibiotics will be administered for its cure. The therapeutic treatment will be directed to control the infection by means of antibiotics and to evaluate the indication for thoracic drainage by thoracostomy. The chosen antibiotic will aim to provide the best source of anti-microbial activity and to have a correct penetration into the pleural space.
The acid contained in the pleural fluid of parapneumonic effusions and/or empyema decreases the effectiveness of aminoglycosides. Metronidazole is not effective in empyemas of this type since it does not reduce the active metabolite in an oxygen-poor environment and it is not effective against anaerobic and microaerophilic Streptococcus either. Chloramphenicol should not be prescribed either, because it can be degraded by the microbial enzymes contained in the pus.
The medical specialist will choose the antibiotic treatment to be used taking into account the type of patient and the characteristics of the pleural fluid. The duration of treatment may vary according to clinical circumstances. Usually high doses are used along with treatment periods of several months.
Which specialist treats it?
The specialist who treats pleural empyema is the pulmonologist. At Top Doctors you will be able to find the best specialist to suit your preferences and you can use various filters to perform your search.