PYOTHORAX OR EMPYEMA – Stages, Etiology and Risk Factors, Types, Signs and Symptoms, Diagnostic Evaluation and Management
- Empyema is a collection of pus (dead cells and infected fluid) inside a body cavity. Usually, this term refers to pus inside the pleural cavity, or ‘pleural space’. The pleural cavity is the thin space between the surface of your lungs and the inner lining of chest wall
- Pleural empyema, also known as pyothorax or purulent pleuritis, is an accumulation of pus in the pleural cavity that can develop when bacteria invade the pleural space, usually in the context of a pneumonia
STAGES OF PYOTHORAX
There are three stages:
- Exudative: when there is an increase in pleural fluid with or without the presence of pus
- Fibrinopurulent: when fibrous septa form localized pus pockets
- Organizing stage: when there is scarring of the pleura membranes with possible inability of the lung to expand
ETIOLOGY AND RISK FACTORS
- It is the complication of the other medical conditions
- Bacteria, fungi
- Lung infections
- After surgery of lung
- COPD
- Lung cancer
- Procedure like thoracentesis
TYPES
There are two classes of empyema: simple and complex
Simple Empyema
- Simple empyema is seen early in the course of the illness. In simple empyema, pus is present, but it is free flowing. Treatment at the simple stage is best, because the pleural cavity can easily be drained
Complex Empyema
- In complex empyema, the inflammation is more severe. The longer the patient have empyema that is left untreated, the greater the chance that it will develop complex empyema
- In cases of severe inflammation, body forms lots of scar tissue in the pleural space. Formation of scar tissue causes the cavity to become divided into multiple, smaller cavities. This is called loculation. Loculation creates complications, because infected areas that have been walled off can be difficult to drain. Complete drainage of pus from the pleural cavity is essential for treatment
SIGNS AND SYMPTOMS
- Fever
- Cough
- Shortness of breath
- Pleurisy: pleurisy is chest pain that occurs when you breathe and is caused by inflammation
- The shortness of breath experienced by patients with empyema occurs when the lungs cannot fully expand
- Fatigue
- Loss of appetite
- Weight loss
- The most severe signs of empyema are associated with sepsis (the presence of bacteria in the blood).
- Signs of sepsis include high fever, chills, rapid breathing, a fast heart rate, and low blood pressure. Sepsis is life-threatening and requires emergency treatment
DIAGNOSTIC EVALUATION
Diagnosis of empyema begins with a complete medical history and physical examination. Tests that are useful for diagnosing empyema include:
- Blood tests, such as:
Blood cultures (to identify what bacterium or organism is causing the infection)
C-reactive protein (CRP) (elevated levels are seen in inflammatory conditions)
White blood cell count (WBC) (elevated levels in inflammatory and infectious conditions)
- X-ray (to diagnose pneumonia, lung abscess document fluid accumulation)
- Thoracentesis (aspiration of pleural fluid for microscopic examination and testing)
- Thoracic ultrasound (use of sound waves to tell if loculations are present)
- CAT scan of the chest (use of computerized X-ray analysis to evaluate the lungs and pleural space)
TREATMENT OPTIONS
- Empyema is treated with intravenous antibiotics, such as cephalosporins, metronidazole, and penicillins with beta-lactamase (ampicillin/sulbactam). Clindamycin can be used for patients who are allergic to penicillin
- Fluids lost, due to lack of appetite and fever, are replaced, and medications such as acetaminophen
- Pleural fluid drainage: a chest tube is used to drain pus from the pleural space and allow the lungs to expand normally
