EMPYEMA (Pyothorax)

Definition: It means the presence of pus in the pleura.

Etiology: Empyema is always secondary to infection in a neighboring structure, usually the lung.

Causes are:
1 Commonest cause is Pneumonia.
(2) Pulmonary tuberculosis.
(3) Bronchiectasis.
(4) Lung abscess or gangrene.
(5) Mediastinal abscess.
6 Carcinoma of the esophagus.
(7) Pericarditis.
(8) Penetrating chest injuries.
[9] Sub-phrenic abscess.
10 Septicemia and pyemia.
(11) In some cases idiopathic.

Causative organisms:

(1) Mycobacterium tuberculi.
2 Pneumococcus.
(3) Streptococci.
4 Escherichia coli.
5 H. Influenzae.
(6) Staphylococci etc.

Clinical Features:

Symptom and signs of the primary disease, usually a history of precedenting attack.
(1) Rising temperature with rigor.
2 Anorexia, malaise, sweating and shivering.
(3) Dyspnoea with increased pulse and respiration rates.
4 Toxemic appearance and pale.
(5) Bulging of intercostals spaces on the affected side; edema of the chest wall.
6 Pulsation may be seen in left sided cases.
(7) Clubbing of fingers.
(8) Offensive breath may be present.

Investigations:

1 Total leukocyte count 15,000 to 20,000 per mm. Sq.

(2) X-ray of chest-shows localized collections of fluid.

(3) Aspirate shows presence of pus. The culture reveals the causative organism.

Complications
(1) Heart failure.
(2) Amyloidosis.
(3) Pyemia.
(4) cerebral abscess.
(5) Bronchial fistula.
(6) Lung abscess or gangrene.
(7) Bronchiectasis.
(8) Pulmonary osteoarthropathy.
[9] Permanent pleural thickening.

In case of early diagnosis, prognosis is good.

Treatment
(1) Absolute bed rest.
(2) Treatment of primary condition.
(3) Exploration of chest and drain of pus.
(4) Soft or semi-solid and nutritious diet; plenty of water to quench thirst.
(5) Fomentation of chest to relieve pain and apply hot to the affected side.
(6) Antibiotics (Penicillin 1 million every 46 hourly or chloramphenicol) may be given.