This document discusses parapneumonic effusion and empyema. It defines a parapneumonic effusion as any pleural effusion associated with bacterial pneumonia, lung abscess, or bronchiectasis. Empyema is specifically defined as pus in the pleural space. It then outlines various treatment options for pleural fluid including observation, therapeutic thoracentesis, tube thoracostomy, intrapleural fibrinolytics, VATS with lysis of adhesions and/or decortication, decortication, and open drainage. It provides details on studies investigating the effectiveness of intrapleural fibrinolytics.

1. Parapnuemonic Effusion &
Empyema
DR SUHAS TIPLE

2. DEFINATION….
Any pleural effusion associated with BACTERIAL PNUMONIA,LUNG
ABSCESS OR BRONCHECTASIS IS A PARAPNUMONIC EFFUSION
EMPYEMA is pus in pleural space

6. Parapnuemonic Effusion &
Empyema
DR SUHAS TIPLE

7. DEFINATION….
Any pleural effusion associated with BACTERIAL PNUMONIA,LUNG
ABSCESS OR BRONCHECTASIS IS A PARAPNUMONIC EFFUSION.
EMPYEMA is pus in pleural space .

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29. Option for management of pleural fluid
• Observation
• Therapeutic thoracentesis
• Tube thoracostomy
• Intrapleural fibronolytics
• VATS with lysis of adhesion and /or decortication
• Decortication
• Open drainage

30. Observation
• Its not acceptable option because pleural fluid from patient with
parapnumonic effusion should be sampled as soon as possible ,

31. Therapeutic thoracentesis
• Its treatment modality for parapneumonic effusion .
• ATS recommended repeated thoracentesis for non tb empyema ,that
were in the early exudative phase .
• In 1968 snider and saleh recommended that pt with empyema could
managed with two therapeutic thoracentesis, but if fluid accumulated
after that time ,tube thoracostomy should be performed.

35. Tube thoracostomy
• Its for complicated parapneumonic effusion
• Tube size relatively large 28 to 36 F old time
• Now small size <14 F size used
• MULTI- CENTERED INTRAPLEURAL SEPSIS (STREPTOKINASE) TRIAL
(MIST 1) : 2005 yr
• CONCLUSSION : intrapleural administration of stk does not improve
mortality , the rate of surgery , or the length of the hospital stay
among pt with pleural infection.

36. • Stk 2.5lack iu or saline for 3 days
• Eligible purulent ,grm stain positive ph below 7.2

37. INTRAPLEURAL FIBRONOLYTICS
• Its for complicated parapnumic effusion
• Mechanism is that destroy the fibrine membrane and facilitate
drainage of pleural fluid.

38. Intrapleural fibrinolytics
• MIST 2 TRIAL (2011)
• CONCLUSSION :
1. intrapleural t-PA-Dnase therapy improved fluid drainage in
patient with pleural infection and reduced the frequency of surgical
referral and duration of the hospital stay .
2. Treatment with Dnase (14.7%)alone t-PA ALONE (17.2%)was
ineffective as compared to administration of combination t-PA and
Dnase (29.5%)significantly greater reduction in pleural opacity .

41. VATS WITH LYSIS OF ADHESSION AND /OR
DECORTICATION
• Its for incompletely drained of parpnuemonic effusion
• Medical thoracoscopy is occasionly used in this situation. VATS
usually preferred because if lung cannot be expanded and it can be
converted to full thoracotomy
• DECORTICATION : All fibrous tissue is removed from visceral and
parietal pleura and all pus is evacuated from pleural space .
• decortication allows underlying lung to expand and eliminate the
pleural sepsis.

43. THANK YOU……!!!