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EMPYEMA THORACIS. Dr. Ashraf A. Esmat A.Prof.Cardio-thoracic surgery Cairo university. Definition. Accumulation of Pus in the Pleural cavity. It comes from the greek word empyein ,which means :pus –producing (suppurates). Aetiology. Lung diseases: Pneumonia (the most common cause)

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empyema thoracis

EMPYEMA THORACIS

Dr. Ashraf A. Esmat

A.Prof.Cardio-thoracic surgery

Cairo university

definition
Definition

Accumulation of Pus in the Pleural cavity.

It comes from the greek word empyein ,which means :pus –producing (suppurates).

aetiology
Aetiology
  • Lung diseases:

Pneumonia (the most common cause)

Lung abscess.

  • Subphrenic abscess.
  • Post traumatic.
  • Iatrogenic.
  • Post-operative.
  • Blood spread .
organisms
Organisms

The most common:

  • Staph.aureus .(90% of causes in infants & children)
  • Strept.pneuomonie.
  • H.influenzae.
pathological stages
Pathological Stages
  • Acute (exudative) stage:

Pleura fills with thin fluid that shows one or more of these criteria;

Ph < 7.4

Glucose <40 mg/dl

LDH> 1000 iu/dl

Protein > 2.5 gm/dl

Sp.gravity >1.018

stages cont
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 cont1
Stages (cont.)
  • Organizing Stage:

Presence of very thick pus .

Thick Inelaastic peel over both pleurae causing entrapment of the lung.

clinical stages
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.

causes of chronicity
Causes of chronicity:
  • Inadequate Tube Drainage.
  • Chronic pulmonary Disease( T.B. or Fungal Infection)
  • Immunosupressed patients.
  • Presence of Foreign body within the pleural space.
symptoms signs
Symptoms & signs
  • Fever
  • Cough & Expectoration.
  • Pleuretic chest pain.
  • Easy fatiguability.
  • Loss of weight.
  • Night sweating.
complications
Complications
  • Rupture into the lung;

BronchoPleural fistula

  • Spread to the subcutaneous tissue;

Empyema Niscitanes

  • Septicaemia & septic shock.
investigations
Investigations
  • Chest X-ray.
  • C-T scan.
  • Ultrasonography
  • Thoracentesis
management
Management
  • Control of the Infection process.
  • Drainage of pus form the pleura.
  • Obliteration of the space & complete Re-expansion of the Lung.
drainage of empyema
Drainage of Empyema
  • Intercostal tube thoracostomy.
  • Intrapleural instillation of streptokinase .
  • V.A.T.S.
  • Rib Resection Drainage.
  • Eloesser Flap .
tube thoracostomy
Tube thoracostomy
  • Indications
  • Technique
  • When to remove
  • When to convert to open drainage
intrapleural streptokinase
Intrapleural Streptokinase
  • Indications
  • Acute or fibrino purulent stage
  • Presence of loculations.
  • Incomplete drainage after tube insertion
  • Contraindications:
  • Chronic stage
  • Post-operative empyema
  • Empyema with BPF.
technique
Technique
  • Streptokinase 25000 iu in 50 cc of 0.9% saline solution.
  • Clamp the tube for 6 hours.
  • Open the clamp and connect tube to suction
video assisted thoracoscopy
Video Assisted Thoracoscopy
  • Indications
  • Technique
  • Limitations
  • complications
rib resection drainage
Rib Resection Drainage
  • Indication
  • Technique
  • Limitations
eloesser flap drainage
Eloesser Flap Drainage
  • Indication.
  • Technique.
  • Advantage.
  • Disadvantage.
reexpansion of the lung obliteration of the space
Reexpansion of the lung & obliteration of the space
  • Decortication.
  • Muscle Transposition.
  • Thoracoplasty.
decortication
Decortication
  • Indications.
  • Technique.
  • Postoperative care.
thoracoplasty
Thoracoplasty
  • Conventional alexander .
  • Tailoring thoracoplasty.
thank you

THANK YOU

GOOD LUCK