Process stages
The development of empyema goes through three successive stages. In the first stage, a thin, clear fluid accumulates around the inflamed lung, which can still be easily removed by puncture. During the second stage, bacteria enter the effusion, fibrin falls out, partitions and pockets form, the liquid becomes thick and cloudy. On the third, a dense shell of connective tissue is formed, which fetters the lung and prevents it from expanding. The earlier treatment is started, the easier it is to remove the pus and the fewer residual changes.
- Exudation stage - liquid transparent effusion
- Stage fibrinous-purulent - partitions and pockets
- Stage of organization - dense membrane around the lung
- Restricted lung mobility
- Risk of pus breaking into the bronchus
- Possible transition to a chronic form
Causes and risk factors
More than half of the cases are associated with pneumonia, especially severe or delayed treatment. Other sources are a lung abscess that has broken into the pleural cavity, penetrating wounds and trauma to the chest, surgery on the chest organs, rupture of the esophagus, purulent processes in the subphrenic space. A separate group is tuberculous empyema. The risk is higher in people with diabetes, alcohol abuse, swallowing disorders, cancer and reduced immunity.
- Complication of pneumonia
- Lung abscess rupture
- Traumas and wounds of the chest
- Operations on the chest organs
- Tuberculosis
- Esophageal rupture and subphrenic abscess
- Diabetes, alcohol, immunodeficiency
Symptoms
Typically, complaints are layered on top of existing pneumonia: the temperature does not decrease or rises again, weakness and sweating increase, and shortness of breath increases. The pain is localized in the side, intensifies with a deep breath and coughing, and sometimes radiates to the shoulder or stomach. The patient tries to lie on the affected side to limit chest movements. If there is a large amount of pus, breathing on this side weakens, and half of the chest may lag when breathing and a puffy face may appear.
- Persistent or recurring fever
- Side pain when breathing
- Increasing shortness of breath
- Weakness, night sweats, weight loss
- Dry cough
- Lagging half of the chest when breathing
- Forced position on the sore side
Diagnostics
X-ray reveals darkening in the lower sections and the level of fluid, but does not allow assessing its nature. Ultrasound examination of the pleural cavity shows the volume of fluid, the presence of septa and helps to choose a point for puncture. Computed tomography clarifies the extent of the process, the condition of the lung and pleura. The puncture is of decisive importance: the resulting liquid is assessed externally and laboratory, the cellular composition, protein, glucose, acidity are determined and is necessarily sent for culture, as well as for research if tuberculosis is suspected.
- Chest X-ray
- Ultrasound of the pleural cavity with assessment of septa
- CT scan of the chest
- Diagnostic puncture of the pleural cavity
- Pleural fluid analysis and culture
- Study on Mycobacterium tuberculosis
- Complete blood count and C-reactive protein
Treatment and recovery
The main principle is that the pus must be removed. With liquid effusion, repeated punctures are sufficient, but more often a drainage is installed through which the contents constantly flow out and the cavity is washed. At the same time, antibacterial therapy is carried out, which is selected based on culture results and continues for several weeks. If the cavity is divided by partitions or the lung does not expand, video thoracoscopy is performed to remove the adhesions, and in the chronic form, surgery to free the lung from the dense membrane. After discharge, breathing exercises and observation are important.
- Drainage of the pleural cavity
- Repeated punctures for liquid effusion
- Long-term antibacterial therapy
- Video thoracoscopic sanitation for septums
- Lung decortication for chronic empyema
- Breathing exercises and early expansion of the lung
- Adequate nutrition and control of concomitant diseases
