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Revista Clinica Espanola Nov 2009About 20% of hospitalized patients with bacterial pneumonia have an accompanying pleural effusion. Parapneumonic effusions (PPE) are associated with a considerable... (Review)
Review
About 20% of hospitalized patients with bacterial pneumonia have an accompanying pleural effusion. Parapneumonic effusions (PPE) are associated with a considerable morbidity and mortality. The main decision in managing a patient with a PPE is whether to insert a chest tube (complicated PPE). Imaging (i.e., chest radiograph, ultrasound and computed tomography) and pleural fluid analysis (i.e., pH, glucose, lactate dehydrogenase, bacterial cults) provide essential information for patient management. Therefore, all PPEs should be aspirated for diagnostic purposes. This may require image-guidance if the effusion is small or heavily loculated. According to the current guidelines, any PPE that fulfills at least one of the following criteria should be drained: size > or = 1/2 of the hemithorax, loculations, pleural fluid pH < 7.20 (or alternatively pleural fluid glucose < 60 mg/dl), positive pleural fluid Gram stain or culture, or purulent appearance. The key components of the treatment of complicated PPE and empyema are the use of appropriate antibiotics, provision of nutritional support, and drainage of the pleural space by one of the following methods: therapeutic thoracentesis, tube thoracostomy, intrapleural fibrinolytics, thoracoscopy with breakdown of adhesions or thoracotomy with decortication. The routine use of intrapleural fibrinolytic therapy remains controversial. (c) 2009 Elsevier España, S.L. All rights reserved.
Topics: Adult; Decision Trees; Empyema, Pleural; Humans; Pleural Effusion
PubMed: 19889319
DOI: 10.1016/s0014-2565(09)72634-7 -
The American Journal of Case Reports Dec 2021BACKGROUND Pyogenic liver abscess is an uncommon entity that is potentially lethal. Pleural empyema and mediastinal collection are 2 rare complications of hepatic...
BACKGROUND Pyogenic liver abscess is an uncommon entity that is potentially lethal. Pleural empyema and mediastinal collection are 2 rare complications of hepatic abscess that negatively impact the prognosis. CASE REPORT Herein, we report 3 cases of pyogenic liver abscesses complicated by pleural empyema, each approached differently, along with a succinct review of the literature. Case 1: A 29-year-old man diagnosed with Crohn's disease presented with Crohn's disease-associated hepatic abscess complicated by pleural empyema and concurrent mediastinal collection. The patient demonstrated significant improvement after administration of intrapleural fibrinolytic therapy. Case 2: A 42-year-old man with unremarkable past medical history presented with abdominal pain and dyspnea. Upon investigation, he was found to have massive pleural empyema secondary to liver abscess. In contrast to case 1, case 2 required pleural debridement via video-assisted thoracoscopic surgery followed by formal decortication through a posterolateral thoracotomy. Thereafter, a dramatic clinical improvement was observed. Case 3: A 26-year-old man with history of brucellosis 6 months before was transferred to our facility as a case of pleural empyema secondary to transdiaphragmatic extension of liver abscess. Unlike case 1 and 2, this patient was managed by drainage of hepatic and pleural collections under radiological guidance only, without the need for intrapleural fibrinolytic therapy or surgical intervention. CONCLUSIONS The current paper sheds light on one of the uncommon complications of hepatic abscess and contributes to this scant literature by summarizing pertinent publications. Adequate drainage remains the cornerstone of any pus collection management despite the complexity of some encountered cases.
Topics: Adult; Empyema, Pleural; Humans; Liver Abscess, Pyogenic
PubMed: 34924559
DOI: 10.12659/AJCR.935169 -
Infectious Disease Clinics of North... Sep 1991Parapneumonic pleural effusions, the most common causes of exudative pleural fluid, are a frequent finding with bacterial pneumonia. Progression to empyema is related to... (Review)
Review
Parapneumonic pleural effusions, the most common causes of exudative pleural fluid, are a frequent finding with bacterial pneumonia. Progression to empyema is related to delay in appropriate antimicrobial therapy. Once an empyema develops, therapy consists of early sterilization of the empyema space with appropriate antibiotics, early and adequate pleural space drainage, and obliteration of the empyema cavity by adequate lung expansion, surgical decortication, or enzymatic debridement.
Topics: Empyema, Pleural; Humans; Pleural Effusion; Pneumonia
PubMed: 1955699
DOI: No ID Found -
Thoracic Surgery Clinics Feb 2018Pleural collections on the side of an obstructing bronchial cancer pose a particular challenge. All efforts should be placed into determining whether the collection is... (Review)
Review
Pleural collections on the side of an obstructing bronchial cancer pose a particular challenge. All efforts should be placed into determining whether the collection is malignant or para-malignant with its significant implications on cancer staging. This article discusses various diagnostic modalities and therapeutic interventions needed for the optimal management of patients presenting with this situation. The order of interventions is dictated by the individual circumstances that patients present with, often requiring the pleural interventions to take place ahead of the bronchial obstruction management.
Topics: Empyema, Pleural; Humans; Lung Neoplasms; Pleural Effusion, Malignant
PubMed: 29150042
DOI: 10.1016/j.thorsurg.2017.09.001 -
Enfermedades Infecciosas Y... Nov 2023Pleural empyema is an infrequent manifestation of extraintestinal Clostridioidesdifficile infection, with just eight cases reported in literature. (Review)
Review
INTRODUCTION
Pleural empyema is an infrequent manifestation of extraintestinal Clostridioidesdifficile infection, with just eight cases reported in literature.
METHODS
We report a new case in a 70-year-old male without comorbidities or evidence of concomitant gastrointestinal disease, and review the previous cases reported in the literature.
RESULTS
The isolate was susceptible to all antimicrobial tested and was negative for A+B toxins. The patient fully recovered after drainages and antimicrobial therapy with amoxicillin-clavulanate and doxycycline.
CONCLUSION
As in the previously reported cases, aspiration was the most plausible hypothesis of mechanism of infection in our patient. Empyema by Clostridioidesdifficile is a diagnostic challenge, since it is necessary to rule out that the isolation of this microorganism in pleural fluid is not a contamination. Furthermore, more evidence is needed for its treatment since data regarding this entity are still scarce.
Topics: Male; Humans; Aged; Clostridioides difficile; Clostridioides; Empyema, Pleural; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents
PubMed: 36707287
DOI: 10.1016/j.eimce.2022.06.015 -
Folia Medica Dec 2023Foreign body (FB) aspiration is a rare incident in adults. Many patients cannot recall the episode of aspiration and are hospitalized with complications of an...
Foreign body (FB) aspiration is a rare incident in adults. Many patients cannot recall the episode of aspiration and are hospitalized with complications of an endobronchial FB.
Topics: Adult; Humans; Bronchoscopy; Respiratory Aspiration; Empyema, Pleural
PubMed: 38351791
DOI: 10.3897/folmed.65.e91076 -
World Journal of Surgery Dec 2016Postoperative pleural empyema following liver resection has not been thoroughly described in the literature yet. Hence, we aimed to describe characteristics of patients...
BACKGROUND
Postoperative pleural empyema following liver resection has not been thoroughly described in the literature yet. Hence, we aimed to describe characteristics of patients experiencing this complication.
METHODS
Characteristics and outcomes of 21 patients who developed pleural empyema after hepatectomy, defined as a bacteriologically proven pleural infection with clinical and biological inflammatory signs requiring antibiotherapy and thoracic drainage, from 2001 to 2014, were retrospectively analyzed.
RESULTS
Overall incidence of pleural empyema was 1 %. Nineteen (90.5 %) patients underwent right or extended right hepatectomy. All 21 patients developed postoperatively pleural effusion and 13 (62 %) infected abdominal collection. They had significantly more bile leakage and intra-abdominal abscesses compared to a matched control group of patients undergoing a right hepatectomy. Accidental diaphragmatic opening was observed in six patients (intra-operatively n = 4, transdiaphragmatic abdominal drainage n = 2). Treatment included percutaneous pleural drainage and in six (29 %) patients a thoracotomy for surgical drainage. Three patients (14 %) died due to sepsis and multiorgan failure. No patient treated by thoracotomy died postoperatively.
CONCLUSION
Postoperative pleural empyema is a rare but serious complication occurring mostly after right hepatectomy complicated with intraabdominal sepsis. Pleural paracentesis for diagnosis and treatment should be rapidly considered. Early thoracotomy for optimal drainage would reduce postoperative mortality.
Topics: Abdominal Abscess; Adolescent; Adult; Aged; Anastomotic Leak; Anti-Bacterial Agents; Chest Tubes; Diaphragm; Drainage; Empyema, Pleural; Female; Hepatectomy; Humans; Male; Middle Aged; Pleural Effusion; Postoperative Complications; Retrospective Studies; Thoracotomy; Young Adult
PubMed: 27464918
DOI: 10.1007/s00268-016-3657-0 -
Thoracic Surgery Clinics Aug 2022Most cases of empyema thoracis are sequelae of severe pneumonia, but chest trauma and complications of chest tube insertion as cause are not uncommon in low-resource... (Review)
Review
Most cases of empyema thoracis are sequelae of severe pneumonia, but chest trauma and complications of chest tube insertion as cause are not uncommon in low-resource settings. Diagnosis is usually delayed due to delayed presentation to health care facilities, low index of suspicion among health care professionals, and inability to properly stage the disease with the available diagnostic tools. Early use of antibiotics and appropriate-sized and well-placed chest tube drainage is associated with good outcomes at a decreased cost. Surgical management of empyema thoracis is indicated when chest tube drainage and antibiotic treatment fail to achieve complete resolution.
Topics: Anti-Bacterial Agents; Chest Tubes; Drainage; Empyema, Pleural; Humans; Thoracic Injuries; Thoracotomy
PubMed: 35961744
DOI: 10.1016/j.thorsurg.2022.02.004 -
The Clinical Respiratory Journal Oct 2021Despite advances in the treatment of pleural infection, up to 20% of patients die. So far, studies assessing the role of intrapleural saline lavage for the management of...
BACKGROUND
Despite advances in the treatment of pleural infection, up to 20% of patients die. So far, studies assessing the role of intrapleural saline lavage for the management of all stage pleural infections are very scarce, usually excluding patients with cancer.
METHODS
The method used was a retrospective cohort study including pleural empyema managed with a pleural lavage of saline solution through a small-bore chest tube. The primary outcome was the rate of failure at 3 months (surgical referral or additional pleural manoeuver due to recurrent infection or all-cause mortality). Secondary outcomes were hospital stay, the change of the chest radiograph and inflammatory biomarkers, and complications.
RESULTS
Thirty patients with pleural empyema were included, 11 (36.7%) with an active cancer. The overall rate of failure at 3 months was 13.3% (surgical referral = 0; additional pleural manoeuver = 3; mortality = 1). Median length of pleural lavage and hospital stay were, respectively, 14 days (7-28) and 17 days (11-42). Inflammatory markers and size of the effusion on chest radiograph significantly decreased for Day 0 to Day 14. No chest tube blockade was reported, but seven (23.3%) accidentally withdrew. No other side effects were reported.
CONCLUSIONS
Intrapleural saline lavage is efficient and safe for the management of pleural empyema, even in severe status patients with cancer, at the cost of a prolonged hospitalization.
Topics: Cohort Studies; Empyema, Pleural; Humans; Pleural Effusion; Retrospective Studies; Saline Solution; Therapeutic Irrigation
PubMed: 34216522
DOI: 10.1111/crj.13415 -
Interactive Cardiovascular and Thoracic... Apr 2017The surgical approach to chronic pleural empyema is still controversial. Video-assisted thoracic surgery (VATS) debridement and decortication has shown favourable...
OBJECTIVES
The surgical approach to chronic pleural empyema is still controversial. Video-assisted thoracic surgery (VATS) debridement and decortication has shown favourable outcomes, while the uniportal VATS (U-VATS) approach is still anecdotal. We report our experience with ultrasonographic (US) preoperative staging followed by U-VATS decortication for pleural empyema.
METHODS
We performed a retrospective analysis of patients who underwent surgical treatment of stage II and stage III pleural empyema from 2012 to 2015. Pre-, intra- and postoperative data were investigated to evaluate outcomes including postoperative complications and disease recurrence. Results were analysed according to preoperative US appearance of pleural space (stages A-E) and surgical approach (thoracotomy vs U-VATS).
RESULTS
We performed 30 (47%) uniportal thoracoscopic pleural decortication and 34 (53%) open decortication for empyema in stage II (40%) or III (60%) obtaining a complete debridement and decortication in all patients. In-hospital mortality was zero and overall morbidity was 29%. U-VATS was associated with lower blood loss (118 ± 80 ml vs 247 ± 140 ml P < 0.001), lower chest tubes duration (5.6 ± 1.4 vs 10.6 ± 4.4 days P < 0.001), shorter hospital stay (6.7 ± 1.9 vs 12.2 ± 4.7 days, P < 0.001) and lower complications (10% vs 16%, P < 0.001). Elevated US patterns (D-E) are associated with thoracotomy, higher blood loss, operative time and a significant incidence of complications.
CONCLUSIONS
Uniportal thoracoscopic decortication for pleural empyema is a safe and effective approach for selected patients based on a combination of clinical and imaging staging. US patterns well corresponded with intraoperative pleural findings and showed a prognostic value.
Topics: Adult; Aged; Chest Tubes; Debridement; Empyema, Pleural; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Patient Selection; Retrospective Studies; Thoracic Surgery, Video-Assisted; Thoracotomy; Ultrasonography
PubMed: 28108575
DOI: 10.1093/icvts/ivw423