Empyema: Difference between revisions
No edit summary |
|||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Pleural space infections with | *Pleural space infections with + Gram stain/culture '''OR''' parapneumonic effusions without pleural fluid sampling | ||
*Stages | *Stages | ||
*#Exudative | *#Exudative - Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr | ||
*#Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely | |||
*#Fibrinopurulent | *#Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion | ||
*#Organizational | ==Presentation== | ||
*Fever | |||
*Shortness of breath | |||
*Anorexia | |||
*Night sweats | |||
*Pleuritic chest pain | |||
*Hemoptysis | |||
*Recent dx and/or treatment of [[Pneumonia]] | |||
*History of penetrating chest trauma or diaphragmatic injury<ref>Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6</ref> | |||
===Causes=== | ===Causes=== | ||
| Line 22: | Line 29: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Pneumonia]] | |||
*[[Sarcoidosis]] | |||
*[[Tuberculosis]] | |||
*[[Pleural Effusion]] | |||
*[[Wegener Granulomatosis]] | |||
*[[Pulmonary embolism]] | |||
==Work Up== | |||
*CBC | |||
*CXR | |||
*[[Thoracentesis]] | |||
*Sputum Culture -- Acid Fast Bacilli (If TB suspected) | |||
*Pulse Ox | |||
*[[ABG interpretation]] | |||
*Blood Cultures | |||
==Diagnosis== | ==Diagnosis== | ||
*Aspiration of purulent | *Aspiration of grossly purulent pleural fluid on [[thoracentesis]] and at least 1 of the following:<ref>http://emedicine.medscape.com/article/807499-overview</ref> | ||
* | **+ Gram stain or culture | ||
* | **WBC count > 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL) | ||
* | **Pleural fluid glucose <60 | ||
* | **pH <7.2 | ||
**LDH >1000 IU/mL | |||
==Treatment== | ==Treatment== | ||
*Treat underlying disease | *Treat underlying disease | ||
*Perform [[thoracentesis]] | *O2 if [[Hypoxemia]] | ||
*Perform [[thoracentesis]] vs. [[chest tube]] if evidence of respiratory distress | |||
**May need Video-Assisted Thoracic surgery (VATS) | |||
*[[Antibiotics]] | *[[Antibiotics]] | ||
**[[Piperacillin-tazobactam]] 3.375-4.5gm q6hr IV or [[imipenem]] 0.5-1gm q6hr | **[[Piperacillin-tazobactam]] 3.375-4.5gm q6hr IV or [[imipenem]] 0.5-1gm q6hr | ||
| Line 41: | Line 66: | ||
==See Also== | ==See Also== | ||
*[[Pleural effusion]] | *[[Pleural effusion]] | ||
*[[Pneumonia]] | |||
*[[Sarcoidosis]] | |||
*[[Tuberculosis]] | |||
== | ==References== | ||
<ref></ref> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:Pulm]] | [[Category:Pulm]] | ||
Revision as of 15:37, 8 June 2015
Background
- Pleural space infections with + Gram stain/culture OR parapneumonic effusions without pleural fluid sampling
- Stages
- Exudative - Free-flowing pleural effusion amenable to chest tube drainage; may only last <48hr
- Fibrinopurulent - Loculations develop making resolution w/ single chest tube drainage unlikely
- Organizational - Takes several weeks to develop; "pleural peel" restricts lung expansion
Presentation
- Fever
- Shortness of breath
- Anorexia
- Night sweats
- Pleuritic chest pain
- Hemoptysis
- Recent dx and/or treatment of Pneumonia
- History of penetrating chest trauma or diaphragmatic injury[1]
Causes
- Pneumonia
- Complications of chest or abdominal trauma
- Esophageal perforation
- Extension from lung abscess
- Osteomyelitis or other near pleural infections
- Hemothorax, chylothorax, or hydrothorax that becomes infected
Clinical Features
- Usually preceded by PNA
- Suspect if symptoms of PNA do not resolve
Differential Diagnosis
Work Up
- CBC
- CXR
- Thoracentesis
- Sputum Culture -- Acid Fast Bacilli (If TB suspected)
- Pulse Ox
- ABG interpretation
- Blood Cultures
Diagnosis
- Aspiration of grossly purulent pleural fluid on thoracentesis and at least 1 of the following:[2]
- + Gram stain or culture
- WBC count > 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL)
- Pleural fluid glucose <60
- pH <7.2
- LDH >1000 IU/mL
Treatment
- Treat underlying disease
- O2 if Hypoxemia
- Perform thoracentesis vs. chest tube if evidence of respiratory distress
- May need Video-Assisted Thoracic surgery (VATS)
- Antibiotics
- Piperacillin-tazobactam 3.375-4.5gm q6hr IV or imipenem 0.5-1gm q6hr
- Consider adding vancomycin if pt at risk for MRSA
Adult Chest Tube Sizes
| Chest Tube Size | Type of Patient | Underlying Causes |
| Small (8-14 Fr) |
|
|
| Medium (20-28 Fr) |
|
|
| Large (36-40 Fr) |
|
See Also
References
Cite error: Invalid <ref> tag; refs with no name must have content
- ↑ Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. Jun 2009;66(6):1672-6
- ↑ http://emedicine.medscape.com/article/807499-overview
- ↑ Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
- ↑ Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.