Pleural empyema

In a pleural empyema is a collection of pus within the pleura ( pleural ), that is between the two Pleurablättern, the pleura ( visceral pleura ) and the pleura ( parietal pleura ). An empyema is defined as purulent effusion into a preformed cavity such as the pleural cavity. An empyema is also referred to synonymously as pyothorax.

Etiology

An empyema developed within the framework of bacterial infections and is a complication of pleurisy ( pleuritis ). In most cases the result of a bacterial Pleuraempyeme lungs (pneumonia ), when it comes from the lungs to the pleura to a transfer of the bacteria. You will then be referred to as parapneumonische Pleuraempyeme. Since it typically comes at Lobärpneumonien to a co-reaction of the pleura in the form of a pleurisy, pneumonia, it is these that lead most often in 2-5 % of cases Pleuraempyemen. According to common pathogens are therefore pneumococci (Streptococcus pneumoniae ), and other pathogens of Lobärpneumonien, such as staphylococci and Klebsiella.

In addition, may be of sepsis Pleuraempyeme complications of lung abscesses, one esophageal perforation, a thoracotomy and follow. For the latter, is also spoken by a septic metastasis.

Symptoms

Patients usually suffer from cough with sputum, chest pain, shortness of breath, high fever, night sweats and weight loss. In the course of antibiotic therapy, the symptoms are often not or only slightly pronounced so that the Pleuraempyeme can first extend almost clinically silent.

Diagnosis

On physical examination, an attenuated breath sounds on auscultation and a damped ( sonorous hypo ) knocking sound in the percussion over the empyema are typical but non-specific. For the diagnosis of Pleuraempyemen usually sufficient a conventional radiograph of the chest. Pleuraempyeme here are marked by a significant decrease in transparency. The accumulation of pus seen in the X-ray image in the form of a mirror formation. In case of unclear findings a CT scan of the chest can be customized.

Therapy

The therapy consists in a Thoraxsaugdrainage and an antibiotic. When chambered Pleuraempyemen thoracoscopy with irrigation and drainage targeted deposit may be required. Older, chronic Pleuraempyeme form so-called " Pleuraschwarten ", in this case also, a thoracotomy with partial pleurectomy, thoracic drainage and possibly insert a drug carrier ( eg Sulmycin - Implant ®, a collagen fleece with gentamicin - addition) are required.

The Ausheilungsergebnis a pleural empyema is usually pleurodesis, so bonding of the visceral and parietal pleura characterized reversed with lubricity between the lung and chest wall.

Swell

• H. Renz - Polster, and Others: Basic Textbook of Internal Medicine. Urban and Fischer Verlag, Munich 2004, 3rd edition, p 502 ISBN 3-437-41052-0
• Grundmann (ed.): Introduction to general pathology. 9th edition, pp. 121 ff Urban and Fischer Verlag Munich 2000 ISBN 3-437-21191-9

• Disease in pneumology
• Bacterial infectious disease of humans
• Bacterial infectious disease in animals
• Disease in thoracic surgery