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03-18-2009, 10:35 AM
Empyema
Def. : Pus in the pleural sac.
Causes 1- pyogenic Lung pneumonia
Subdiaphragmatic Amoebic abscess.
Mediastinal infection
2- TB (tuberculous empyema) !?
C/P
Cause lung abscess, pneumonia
Symptoms
General Local
Severe FAHM Cough
(Toxemia) Dyspnea
Chest pain:
dull aching Pain
pleural Stitching pain.
Signs: 1- General toxemic signs.
Inspection Movement
2- Local signs Palpation Mediastinal. Shift
TVF
Auscultation intensity of breath
sounds or diminished air entery
Percussion Stony dull
Complication
1- pulmonary fibrosis
2- Bronchopleural fistula: Pus cells destroy lung parenchyma So connection between Pleura & bronchus So pus get from pleural space bronchus.
N.B. empyema + bronchopleural fistula
= Supp. Lung $
= cavitary lung $

3- Amyloidosis kid. Nephrotic $
4- Empyema necessitans
Investigations:
1- X-ray opacity of effusion
2- Aspiration culture & Sensitivity& Z.N. for T.B.
Treatment of empyema: (pyogenic)
Acute characterized by thin fluids
1- Ab ­ doses according to C. & S.
2- + lntercostal , tube free drainage.
Chronic : (of duration> 2m.)
↓ 1- antibiotic
Thick fluids 2- intercostal tube (not effective)
3- open drainage.




rib resection hole in pleura & dissect
adhesions within pleural cavity
4- Decortication:

= removal of pleura provided that the patient with good general condition
N.B. (another opinion)
In chronic empyema
Underlying lung normal underlying fibrosis

Decortication Pneumonectomy If the
other lung is normal.


Treatment of (tuberculous empyema)
* Anti T.B
* Intercostal tube.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)