This document discusses the pulmonary manifestations of connective tissue disorders. It covers several conditions including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. Key points include that interstitial lung disease is a major complication and cause of death. Specific lung diseases discussed include pulmonary hypertension, diffuse alveolar hemorrhage, lupus pneumonitis, and necrobiotic nodules. Treatment involves immunosuppression with medications like cyclophosphamide and mycophenolate mofetil.
This document provides information on pleural empyema, including its definition, etiology, stages, symptoms, investigations, and management. Pleural empyema, also known as pyothorax, is the accumulation of pus in the pleural cavity. It can develop as a complication of conditions like pneumonia or following trauma. Management involves treating the infection with antibiotics, draining the pus via procedures like chest tube insertion or VATS, and re-expanding the lung. Treatment may also include procedures like thoracocentesis, fibrinolytics, or open drainage if more invasive measures are needed.
This document provides information on empyema, including its definition, etiology, stages, symptoms, investigations, and management. Empyema is defined as infection of the pleural space resulting in pus accumulation. It is usually caused by bacteria spreading from a pneumonia or other infection. It progresses through exudative, fibrinopurulent, and organizing stages. Symptoms include fever, cough, chest pain, and shortness of breath. Diagnosis involves imaging like chest X-ray or CT scan and thoracentesis. Management includes antibiotics, chest tube drainage, fibrinolytics, VATS, and sometimes open drainage or decortication surgery. The goal is to treat infection, drain pus, and re-expand
Atelectasis is the collapse or closure of part or all of the lung resulting in reduced gas exchange. It can be primary, due to prematurity or lung immaturity, or secondary due to obstruction from mucus, tumors, or surgery. Symptoms include rapid shallow breathing, cough, hypoxia, and fever. Diagnosis involves chest x-ray, sputum tests, and CT scans. Treatment focuses on positioning, suctioning mucus, oxygen therapy, and preventing infections. Nursing care manages breathing, airway clearance, gas exchange, and monitors for complications like infections.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
Pulmonary embolism occurs when a blood clot blocks an artery in the lungs, usually originating from deep vein thrombosis. Symptoms range from sudden shortness of breath to chest pain. Diagnosis involves tests like CT scans, V/Q scans, echocardiograms and blood tests. Treatment consists of oxygen, anticoagulant drugs, and sometimes fibrinolytics for massive clots. Long term prevention focuses on continued anticoagulation and devices like IVC filters for recurrent embolisms despite treatment.
Bacterial pneumonia can result in parapneumonic effusions or empyema in the pleural space in about 40% of hospitalized cases. Empyema is defined as pus in the pleural space. Effusions are classified into exudative, fibropurulent, and organized stages. Common bacteria include Staphylococcus aureus, Streptococcus pneumoniae, and various gram-negative rods. Diagnosis involves chest imaging, microbiology of pleural fluid, and biochemistry of the fluid. Treatment involves antibiotics, tube thoracostomy, possible intrapleural fibrinolytics or antibiotics, and potentially more invasive procedures like thoracoscopy or thoracotomy if the effusion becomes complicated or organized
Dr. Jakeer Hussain discusses pneumothorax, beginning with an introduction and definition. He then covers the classification of pneumothorax as either spontaneous, traumatic, or iatrogenic. Spontaneous pneumothorax is further classified as primary or secondary. The document discusses signs, symptoms, investigations including x-ray and CT scan findings, differential diagnosis, quantification methods, and various treatment options including observation, oxygen supplementation, needle aspiration, tube thoracostomy, medical or VATS pleurodesis, and open thoracotomy.
This document discusses the pulmonary manifestations of connective tissue disorders. It covers several conditions including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. Key points include that interstitial lung disease is a major complication and cause of death. Specific lung diseases discussed include pulmonary hypertension, diffuse alveolar hemorrhage, lupus pneumonitis, and necrobiotic nodules. Treatment involves immunosuppression with medications like cyclophosphamide and mycophenolate mofetil.
This document provides information on pleural empyema, including its definition, etiology, stages, symptoms, investigations, and management. Pleural empyema, also known as pyothorax, is the accumulation of pus in the pleural cavity. It can develop as a complication of conditions like pneumonia or following trauma. Management involves treating the infection with antibiotics, draining the pus via procedures like chest tube insertion or VATS, and re-expanding the lung. Treatment may also include procedures like thoracocentesis, fibrinolytics, or open drainage if more invasive measures are needed.
This document provides information on empyema, including its definition, etiology, stages, symptoms, investigations, and management. Empyema is defined as infection of the pleural space resulting in pus accumulation. It is usually caused by bacteria spreading from a pneumonia or other infection. It progresses through exudative, fibrinopurulent, and organizing stages. Symptoms include fever, cough, chest pain, and shortness of breath. Diagnosis involves imaging like chest X-ray or CT scan and thoracentesis. Management includes antibiotics, chest tube drainage, fibrinolytics, VATS, and sometimes open drainage or decortication surgery. The goal is to treat infection, drain pus, and re-expand
Atelectasis is the collapse or closure of part or all of the lung resulting in reduced gas exchange. It can be primary, due to prematurity or lung immaturity, or secondary due to obstruction from mucus, tumors, or surgery. Symptoms include rapid shallow breathing, cough, hypoxia, and fever. Diagnosis involves chest x-ray, sputum tests, and CT scans. Treatment focuses on positioning, suctioning mucus, oxygen therapy, and preventing infections. Nursing care manages breathing, airway clearance, gas exchange, and monitors for complications like infections.
The discovery of malignant cells in pleural fluid
and/or parietal pleura signifies disseminated or
advanced disease and a reduced life expectancy in
patients with cancer.Median survival following
diagnosis ranges from 3 to 12 months and is
dependent on the stage and type of the underlying
malignancy. The shortest survival time is observed
in malignant effusions secondary to lung cancer
and the longest in ovarian cancer, while malignant
effusions due to an unknown primary have an
intermediate survival time.Historically, studies
showed that median survival times in effusions due
to carcinoma of the breast are 5-6 months.
However, more recent studies have suggested
longer survival times of up to 15 months. A
comparison of survival times in breast cancer
effusions in published studies to 1994 calculated
a median survival of 11 months.9
Currently, lung cancer is the most common
metastatic tumour to the pleura in men and breast
cancer in women.Together, both malignancies
account for 50- 65% of all malignant effusions. Lymphomas, tumours of the genitourinary
tract and gastrointestinal tract account for
a further 25% Pleural effusions from an
unknown primary are responsible for 15% of all
malignant pleural effusions.Few studies have
estimated the proportion of pleural effusions due to
mesothelioma: studies from 1975, 1985 and 1987
identified mesothelioma in 1/271, 3/472 and 22/592
patients, respectively, but there are no more recent
data to update this in light of the increasing incidence
of mesothelioma.
Pulmonary embolism occurs when a blood clot blocks an artery in the lungs, usually originating from deep vein thrombosis. Symptoms range from sudden shortness of breath to chest pain. Diagnosis involves tests like CT scans, V/Q scans, echocardiograms and blood tests. Treatment consists of oxygen, anticoagulant drugs, and sometimes fibrinolytics for massive clots. Long term prevention focuses on continued anticoagulation and devices like IVC filters for recurrent embolisms despite treatment.
Bacterial pneumonia can result in parapneumonic effusions or empyema in the pleural space in about 40% of hospitalized cases. Empyema is defined as pus in the pleural space. Effusions are classified into exudative, fibropurulent, and organized stages. Common bacteria include Staphylococcus aureus, Streptococcus pneumoniae, and various gram-negative rods. Diagnosis involves chest imaging, microbiology of pleural fluid, and biochemistry of the fluid. Treatment involves antibiotics, tube thoracostomy, possible intrapleural fibrinolytics or antibiotics, and potentially more invasive procedures like thoracoscopy or thoracotomy if the effusion becomes complicated or organized
Dr. Jakeer Hussain discusses pneumothorax, beginning with an introduction and definition. He then covers the classification of pneumothorax as either spontaneous, traumatic, or iatrogenic. Spontaneous pneumothorax is further classified as primary or secondary. The document discusses signs, symptoms, investigations including x-ray and CT scan findings, differential diagnosis, quantification methods, and various treatment options including observation, oxygen supplementation, needle aspiration, tube thoracostomy, medical or VATS pleurodesis, and open thoracotomy.
This document discusses various congenital lung abnormalities including pulmonary agenesis, hypoplasia, cystic malformations, sequestrations, bronchogenic cysts, lymphangiectasia, hernias, and lobar emphysema. It describes the pathogenesis, clinical presentation, diagnostic evaluation, and management of each condition. Surgical resection is often recommended for localized lesions that are symptomatic or have malignant potential, while supportive care is emphasized for diffuse abnormalities.
1. Empyema is defined as pus within the pleural cavity, most commonly caused by bacterial pneumonia or lung infection spreading to the pleura.
2. It progresses through exudative, fibrinopurulent, and organizational stages as pus and fibrin deposits build up. This can lead to restricted lung movement and formation of a thick pleural peel.
3. Diagnosis involves chest imaging, thoracentesis of empyema fluid for appearance, microbiology, and biochemical analysis showing low pH, glucose and high LDH levels.
The document discusses pulmonary eosinophilias, which are a heterogeneous group of disorders characterized by varying degrees of pulmonary or blood eosinophilia. It classifies the main types as Loeffler's syndrome, drug and toxin induced eosinophilic pneumonia, tropical pulmonary eosinophilia, and allergic bronchopulmonary aspergillosis. Loeffler's syndrome is characterized by transient pulmonary infiltrates associated with eosinophilia caused by parasites. Tropical pulmonary eosinophilia is caused by a hypersensitivity reaction to filarial parasites. Allergic bronchopulmonary aspergillosis involves a hypersensitivity response to inhaled fungal antigens like Aspergillus.
Pyothorax, or empyema thoracis, is an accumulation of pus in the pleural cavity that is usually caused by bacterial pneumonia. It progresses through three stages - exudative, fibrinopurulent, and organizing. Symptoms include chest pain, cough, fever, and shortness of breath. Diagnosis involves chest x-ray, CT scan, and thoracentesis of pleural fluid. Treatment requires antibiotics, drainage of pus from the pleural space, and sometimes surgical procedures like VATS to debride the pleural space and allow for lung re-expansion. Complications can include bronchopleural fistula, spread of infection, and sepsis.
The document discusses hemoptysis (coughing up blood from the lungs). It defines hemoptysis and outlines several learning objectives related to understanding the condition. Key points include:
- Hemoptysis is defined as spitting up blood originating from the lungs or bronchial tubes. Massive hemoptysis refers to coughing up over 100mL-1000mL of blood in 24 hours.
- Causes can include infections like tuberculosis, lung cancers, injuries or disorders affecting blood vessels in the lungs. Diagnostic tests include imaging like chest x-rays and CT scans, as well as sputum cultures and bronchoscopy.
- Treatment depends on the severity but may include medications to stop
This document discusses empyema, a type of pleural infection. It begins by outlining the aims and introduction. It then covers the pathogenesis and types of paraneumonic pleural effusions. Diagnosis involves thoracentesis and pleural fluid analysis. Common causative bacteria include streptococcus, staphylococcus aureus, and anaerobes. Treatment requires accurate diagnosis, appropriate antibiotic therapy guided by cultures, drainage of infected material via chest tube, and potential intrapleural therapies. Complications can arise if not properly treated.
This document provides guidance on evaluating and managing patients presenting with hemoptysis. It defines hemoptysis and outlines its various classifications based on blood loss. Common causes are discussed, including tuberculosis, bronchial carcinoma, bronchiectasis, and lung abscesses. A systematic approach to evaluation is recommended, beginning with history, physical exam, chest imaging, and sputum/blood tests. Bronchoscopy can help localize the bleeding site but is usually best delayed until acute bleeding subsides. The goal is to determine the cause and initiate appropriate treatment while stabilizing patients experiencing massive hemorrhage.
Cylindrical bronchiectasis appears on radiographs as tram line signs, where the bronchi have uniform calibers and parallel walls. Cystic bronchiectasis manifests as multiple ring shadows that may contain air-fluid levels. Extensive bronchiectasis can show a honeycombing pattern of multiple conglomerating cysts.
- The document discusses pneumothorax, describing its classification, pathogenesis, clinical presentation, diagnosis, and treatment options.
- Key points include that tension pneumothorax can cause rapid deterioration and requires immediate treatment, while spontaneous pneumothorax is classified as primary or secondary depending on underlying lung health.
- Treatment involves observation for small primary pneumothoraces or procedures like aspiration, chest tube placement, or surgery depending on the size and symptoms.
This document outlines various complications that can arise from pulmonary tuberculosis, including hemoptysis, pleurisy, pleural effusion, empyema, pneumothorax, aspergilloma, endobronchitis, bronchiectasis, laryngitis, cor pulmonale, carcinoma of the bronchus, tuberculous enteritis, and miliary tuberculosis. It describes the mechanisms, symptoms, diagnostic approach, and treatment for each complication.
This document discusses chylothorax, which is a type of pleural effusion that results from lymph called chyle accumulating in the pleural cavity due to disruption or obstruction of the thoracic duct. It can occur after cardiothoracic surgeries in 0.2-1% of cases. Symptoms include respiratory difficulty, malnutrition, and decreased breath sounds. Diagnosis involves analyzing pleural fluid for triglyceride levels. Treatment begins conservatively with drainage, diet modification, and medications, but may require surgical ligation of the thoracic duct if conservative measures fail.
Bronchopulmonary sequestration (BPS) is a rare congenital lung malformation where non-functioning lung tissue receives its blood supply from systemic arteries instead of the pulmonary circulation. It can be intralobar, located within a normal lung lobe, or extralobar, located outside the normal lung with its own pleura. Intralobar BPS presents most often in childhood or adulthood with recurrent pulmonary infections, while extralobar BPS usually presents in infancy with respiratory distress and has a higher association with other congenital anomalies. CT angiography is the preferred imaging method to evaluate BPS and delineate the anomalous systemic arterial supply.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
- Hemoptysis is the expectoration of blood from the respiratory tract below the level of the vocal cords. It can range from blood-streaked sputum to gross blood. It is classified as minor (<20mL/day), moderate (20-100mL/day), or massive (100-600mL/day).
- The bronchial arteries, which arise from the aorta, are responsible for 95% of hemoptysis cases as they have higher systemic pressure. The pulmonary arteries have lower pressure and carry only a small portion of cardiac output.
- Common causes of hemoptysis include tuberculosis, bronchiectasis, mycetoma, lung abscess, mitral stenosis, and
This document discusses congenital disorders of the lung, including abnormalities in development, tracheobronchial structures, and lung parenchyma. It covers topics such as tracheal agenesis, stenosis, and tracheoesophageal fistula under tracheobronchial abnormalities. Paranchymal abnormalities discussed include lung agenesis/hypoplasia and pulmonary sequestration. Sequestrations are classified as intralobar or extralobar depending on blood supply and location within or outside the lung. The document provides details on clinical presentation, diagnosis, and treatment of various congenital lung disorders.
Pleural effusion results from an imbalance between pleural fluid formation and absorption, causing fluid to accumulate in the pleural space. Fluid formation occurs through capillaries in the parietal pleura, and absorption occurs via lymphatic vessels. When the rate of formation exceeds absorption, effusion occurs. Effusions are classified as transudative or exudative based on fluid characteristics. Diagnostic testing of pleural fluid aims to determine the cause of effusion. Radiography and ultrasound are used to identify and characterize pleural fluid.
A 78-year-old male presented with cough, breathlessness, chest pain and haemoptysis. He had a history of pulmonary tuberculosis treated 2 years prior. Investigations revealed a cavitary lesion in his left lung containing a fungal mass. He was diagnosed with pulmonary aspergilloma developing in a pre-existing cavity from prior tuberculosis. Pulmonary aspergilloma occurs due to the fungus Aspergillus fumigatus infecting cavities left by healed tuberculosis. It was treated successfully with intravenous amphotericin B and oral itraconazole for 6 months. Relevant examinations and tests are needed to differentiate pulmonary aspergilloma from other conditions like lung cancer and properly
This document discusses pleural effusions, including their mechanism, normal composition, differentiation between transudative and exudative effusions, and causes. It provides details on parapneumonic effusions and empyema, including classification and treatment approaches. Specific conditions discussed in detail include tuberculous pleural effusions, effusions in HIV patients, chylothorax, pseudochylothorax, and malignant pleural effusions. Useful pleural fluid tests are also summarized.
Lymphangioleiomyomatosis (LAM) is a rare lung disease that affects premenopausal women. It involves the proliferation of abnormal smooth muscle-like cells (LAM cells) in the lungs, lymphatic system, and kidneys. This leads to cyst formation in the lungs and lymphatic obstruction, causing symptoms like shortness of breath, pneumothorax, chylous ascites, and lymphangioleiomyomas. The disease has links to tuberous sclerosis complex and is exacerbated by estrogen. Diagnosis involves imaging and biopsy to identify LAM cells. Treatment focuses on managing symptoms, with lung transplantation as a last resort.
- Lung abscess is defined as necrosis of lung tissue forming cavities containing necrotic debris caused by microbial infection. It is most commonly caused by aspiration, necrotizing pneumonia, chronic pneumonia, or tuberculosis.
- Symptoms include fever, cough, and shortness of breath. CT scan is the most sensitive imaging method and shows rounded cavities that may contain fluid or air-fluid levels with surrounding consolidation.
- Treatment involves prolonged antibiotics and physiotherapy. Larger abscesses over 4cm have worse prognosis and sometimes require drainage procedures or surgery. Complications can include empyema or bronchopleural fistula.
This document discusses various congenital lung abnormalities including pulmonary agenesis, hypoplasia, cystic malformations, sequestrations, bronchogenic cysts, lymphangiectasia, hernias, and lobar emphysema. It describes the pathogenesis, clinical presentation, diagnostic evaluation, and management of each condition. Surgical resection is often recommended for localized lesions that are symptomatic or have malignant potential, while supportive care is emphasized for diffuse abnormalities.
1. Empyema is defined as pus within the pleural cavity, most commonly caused by bacterial pneumonia or lung infection spreading to the pleura.
2. It progresses through exudative, fibrinopurulent, and organizational stages as pus and fibrin deposits build up. This can lead to restricted lung movement and formation of a thick pleural peel.
3. Diagnosis involves chest imaging, thoracentesis of empyema fluid for appearance, microbiology, and biochemical analysis showing low pH, glucose and high LDH levels.
The document discusses pulmonary eosinophilias, which are a heterogeneous group of disorders characterized by varying degrees of pulmonary or blood eosinophilia. It classifies the main types as Loeffler's syndrome, drug and toxin induced eosinophilic pneumonia, tropical pulmonary eosinophilia, and allergic bronchopulmonary aspergillosis. Loeffler's syndrome is characterized by transient pulmonary infiltrates associated with eosinophilia caused by parasites. Tropical pulmonary eosinophilia is caused by a hypersensitivity reaction to filarial parasites. Allergic bronchopulmonary aspergillosis involves a hypersensitivity response to inhaled fungal antigens like Aspergillus.
Pyothorax, or empyema thoracis, is an accumulation of pus in the pleural cavity that is usually caused by bacterial pneumonia. It progresses through three stages - exudative, fibrinopurulent, and organizing. Symptoms include chest pain, cough, fever, and shortness of breath. Diagnosis involves chest x-ray, CT scan, and thoracentesis of pleural fluid. Treatment requires antibiotics, drainage of pus from the pleural space, and sometimes surgical procedures like VATS to debride the pleural space and allow for lung re-expansion. Complications can include bronchopleural fistula, spread of infection, and sepsis.
The document discusses hemoptysis (coughing up blood from the lungs). It defines hemoptysis and outlines several learning objectives related to understanding the condition. Key points include:
- Hemoptysis is defined as spitting up blood originating from the lungs or bronchial tubes. Massive hemoptysis refers to coughing up over 100mL-1000mL of blood in 24 hours.
- Causes can include infections like tuberculosis, lung cancers, injuries or disorders affecting blood vessels in the lungs. Diagnostic tests include imaging like chest x-rays and CT scans, as well as sputum cultures and bronchoscopy.
- Treatment depends on the severity but may include medications to stop
This document discusses empyema, a type of pleural infection. It begins by outlining the aims and introduction. It then covers the pathogenesis and types of paraneumonic pleural effusions. Diagnosis involves thoracentesis and pleural fluid analysis. Common causative bacteria include streptococcus, staphylococcus aureus, and anaerobes. Treatment requires accurate diagnosis, appropriate antibiotic therapy guided by cultures, drainage of infected material via chest tube, and potential intrapleural therapies. Complications can arise if not properly treated.
This document provides guidance on evaluating and managing patients presenting with hemoptysis. It defines hemoptysis and outlines its various classifications based on blood loss. Common causes are discussed, including tuberculosis, bronchial carcinoma, bronchiectasis, and lung abscesses. A systematic approach to evaluation is recommended, beginning with history, physical exam, chest imaging, and sputum/blood tests. Bronchoscopy can help localize the bleeding site but is usually best delayed until acute bleeding subsides. The goal is to determine the cause and initiate appropriate treatment while stabilizing patients experiencing massive hemorrhage.
Cylindrical bronchiectasis appears on radiographs as tram line signs, where the bronchi have uniform calibers and parallel walls. Cystic bronchiectasis manifests as multiple ring shadows that may contain air-fluid levels. Extensive bronchiectasis can show a honeycombing pattern of multiple conglomerating cysts.
- The document discusses pneumothorax, describing its classification, pathogenesis, clinical presentation, diagnosis, and treatment options.
- Key points include that tension pneumothorax can cause rapid deterioration and requires immediate treatment, while spontaneous pneumothorax is classified as primary or secondary depending on underlying lung health.
- Treatment involves observation for small primary pneumothoraces or procedures like aspiration, chest tube placement, or surgery depending on the size and symptoms.
This document outlines various complications that can arise from pulmonary tuberculosis, including hemoptysis, pleurisy, pleural effusion, empyema, pneumothorax, aspergilloma, endobronchitis, bronchiectasis, laryngitis, cor pulmonale, carcinoma of the bronchus, tuberculous enteritis, and miliary tuberculosis. It describes the mechanisms, symptoms, diagnostic approach, and treatment for each complication.
This document discusses chylothorax, which is a type of pleural effusion that results from lymph called chyle accumulating in the pleural cavity due to disruption or obstruction of the thoracic duct. It can occur after cardiothoracic surgeries in 0.2-1% of cases. Symptoms include respiratory difficulty, malnutrition, and decreased breath sounds. Diagnosis involves analyzing pleural fluid for triglyceride levels. Treatment begins conservatively with drainage, diet modification, and medications, but may require surgical ligation of the thoracic duct if conservative measures fail.
Bronchopulmonary sequestration (BPS) is a rare congenital lung malformation where non-functioning lung tissue receives its blood supply from systemic arteries instead of the pulmonary circulation. It can be intralobar, located within a normal lung lobe, or extralobar, located outside the normal lung with its own pleura. Intralobar BPS presents most often in childhood or adulthood with recurrent pulmonary infections, while extralobar BPS usually presents in infancy with respiratory distress and has a higher association with other congenital anomalies. CT angiography is the preferred imaging method to evaluate BPS and delineate the anomalous systemic arterial supply.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
- Hemoptysis is the expectoration of blood from the respiratory tract below the level of the vocal cords. It can range from blood-streaked sputum to gross blood. It is classified as minor (<20mL/day), moderate (20-100mL/day), or massive (100-600mL/day).
- The bronchial arteries, which arise from the aorta, are responsible for 95% of hemoptysis cases as they have higher systemic pressure. The pulmonary arteries have lower pressure and carry only a small portion of cardiac output.
- Common causes of hemoptysis include tuberculosis, bronchiectasis, mycetoma, lung abscess, mitral stenosis, and
This document discusses congenital disorders of the lung, including abnormalities in development, tracheobronchial structures, and lung parenchyma. It covers topics such as tracheal agenesis, stenosis, and tracheoesophageal fistula under tracheobronchial abnormalities. Paranchymal abnormalities discussed include lung agenesis/hypoplasia and pulmonary sequestration. Sequestrations are classified as intralobar or extralobar depending on blood supply and location within or outside the lung. The document provides details on clinical presentation, diagnosis, and treatment of various congenital lung disorders.
Pleural effusion results from an imbalance between pleural fluid formation and absorption, causing fluid to accumulate in the pleural space. Fluid formation occurs through capillaries in the parietal pleura, and absorption occurs via lymphatic vessels. When the rate of formation exceeds absorption, effusion occurs. Effusions are classified as transudative or exudative based on fluid characteristics. Diagnostic testing of pleural fluid aims to determine the cause of effusion. Radiography and ultrasound are used to identify and characterize pleural fluid.
A 78-year-old male presented with cough, breathlessness, chest pain and haemoptysis. He had a history of pulmonary tuberculosis treated 2 years prior. Investigations revealed a cavitary lesion in his left lung containing a fungal mass. He was diagnosed with pulmonary aspergilloma developing in a pre-existing cavity from prior tuberculosis. Pulmonary aspergilloma occurs due to the fungus Aspergillus fumigatus infecting cavities left by healed tuberculosis. It was treated successfully with intravenous amphotericin B and oral itraconazole for 6 months. Relevant examinations and tests are needed to differentiate pulmonary aspergilloma from other conditions like lung cancer and properly
This document discusses pleural effusions, including their mechanism, normal composition, differentiation between transudative and exudative effusions, and causes. It provides details on parapneumonic effusions and empyema, including classification and treatment approaches. Specific conditions discussed in detail include tuberculous pleural effusions, effusions in HIV patients, chylothorax, pseudochylothorax, and malignant pleural effusions. Useful pleural fluid tests are also summarized.
Lymphangioleiomyomatosis (LAM) is a rare lung disease that affects premenopausal women. It involves the proliferation of abnormal smooth muscle-like cells (LAM cells) in the lungs, lymphatic system, and kidneys. This leads to cyst formation in the lungs and lymphatic obstruction, causing symptoms like shortness of breath, pneumothorax, chylous ascites, and lymphangioleiomyomas. The disease has links to tuberous sclerosis complex and is exacerbated by estrogen. Diagnosis involves imaging and biopsy to identify LAM cells. Treatment focuses on managing symptoms, with lung transplantation as a last resort.
- Lung abscess is defined as necrosis of lung tissue forming cavities containing necrotic debris caused by microbial infection. It is most commonly caused by aspiration, necrotizing pneumonia, chronic pneumonia, or tuberculosis.
- Symptoms include fever, cough, and shortness of breath. CT scan is the most sensitive imaging method and shows rounded cavities that may contain fluid or air-fluid levels with surrounding consolidation.
- Treatment involves prolonged antibiotics and physiotherapy. Larger abscesses over 4cm have worse prognosis and sometimes require drainage procedures or surgery. Complications can include empyema or bronchopleural fistula.
This document discusses lung abscess, including its definition, causes, microbiology, risk factors, clinical presentation, diagnosis and treatment. A lung abscess is a localized infection and necrosis of lung tissue, often caused by aspiration of oral or gastric contents, that produces a cavity within the lung. It commonly presents with cough, sputum production and fever. Diagnosis is made through chest imaging showing a lung cavity. Treatment involves prolonged use of antibiotics active against the typical bacterial causes, such as clindamycin and metronidazole, for 4-6 weeks.
Bacterial destruction of the lungs can lead to serious complications like lung abscesses and pleural effusions. Lung abscesses form when bacteria destroy lung tissue, causing necrosis and pus-filled cavities. Left untreated, the abscess can drain into the pleural cavity, causing a pleural effusion. Pleural effusions are accumulations of fluid in the pleural space that can become infected (pyothorax) or allow air to enter (pyopneumothorax), requiring drainage to prevent respiratory distress. Proper treatment involves identifying the underlying infection through testing of pleural fluid, administering antibiotics, and draining excess fluid or air in the pleural cavity through chest tubes or thoracentesis.
Diseases of the lungs, especially pneumonia, are leading causes of pediatric morbidity and mortality. Pneumonia is often treated successfully with antibiotics by pediatricians, but sometimes leads to complications requiring surgery. Common complications of bacterial pneumonia include lung abscesses, pleural effusions, pyothorax (pus in the pleural cavity), and pyopneumothorax (pus and air in the pleural cavity). These complications are treated through drainage procedures, antibiotics, and addressing the underlying infection.
This document discusses the pleura, pleural cavity, and pleural effusions. It defines the pleura and pleural cavity, and describes different types of pleural disease including pleurisy and pleural effusions. It covers the etiology, pathogenesis, signs and symptoms, diagnosis, and treatment of various pleural effusions such as exudative effusions, transudative effusions, parapneumonic effusions, empyema, hemothorax, and chylothorax. Evaluation involves thoracentesis, chest x-ray, and biopsy when needed. Management depends on the cause but may include antibiotics, tube thoracostomy, pleurodesis, surgery such as VATS,
Pneumonia is an infection that causes inflammation in the lungs. It can be caused by bacteria, viruses, or other microorganisms. Common symptoms include cough, fever, chills, and difficulty breathing. Pneumonia is diagnosed based on symptoms and chest x-ray findings. Treatment involves antibiotics, oxygen therapy, and fluids. Vaccines can help prevent pneumococcal pneumonia. Complications may include lung abscesses or fluid in the chest if not properly treated.
The document discusses empyema thoracis, beginning with definitions and a brief history. It describes the stages of empyema development from parapneumonic effusion to organized empyema. Common causes include bacterial pneumonias. Diagnosis involves pleural fluid analysis and imaging. Management includes antibiotics, drainage, and surgery if drainage fails. Surgical options range from VATS to open procedures depending on severity.
Pneumonia is characterized by the emergence of new lung infiltrates, accompanied by clinical signs such as fever, purulent sputum, leukocytosis, and decreased oxygenation and Nosocomial Pneumonia is a non-incubating lower respiratory infection that presents clinically two or more days after hospitalization. In this presentation "Nosocomial Pneumonias" has been described including their causes, therapy, Principles, diagnosis, symptoms, management, etc. For more information, please contact us: 9779030507.
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
Lung abscess is caused by microbial infection that leads to necrosis of lung tissue, forming a cavity. Symptoms include cough, expectoration of purulent sputum, and abnormalities on imaging. Lung abscesses are usually polymicrobial infections from oral anaerobes following aspiration. Risk factors include predisposition to aspiration, poor dental health, and conditions compromising immunity. Diagnosis involves chest imaging showing cavitary lesions and microbiological testing of sputum or lung aspirates. Treatment involves antibiotics and drainage of complications like empyema.
Pleural empyema is pus in the pleural space, first described by Hippocrates. It develops from parapneumonic effusions caused by bacterial pneumonia. Clinical features include fever, chest pain, and dyspnea. Diagnosis is confirmed by cloudy pleural fluid on thoracentesis with positive cultures. Imaging shows pleural thickening and loculations. Treatment involves antibiotics, chest tube drainage for drainage and lung re-expansion, and drainage of at least 3 weeks.
This document provides information on pneumonia including:
1. Pneumonia is defined as an inflammation of the lung parenchyma that can be caused by microorganisms or non-infectious causes. Pneumonia is classified based on location (lobar, bronchopneumonia, interstitial), source (community acquired, hospital acquired, ventilator associated), and causative agent (bacterial, viral, fungal).
2. Common bacterial causes include Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae. Viral causes include influenza, RSV, and parainfluenza. Predisposing factors include age, underlying diseases, environment, drugs
Updates in Parapneumonic Effusion and EmpyemaGamal Agmy
The document discusses parapneumonic effusion and empyema. It classifies pneumonias and defines related terms like pleurisy, parapneumonic effusion, and empyema. It describes the pathophysiology of effusions in stages from pleuritis sicca to organization. Clinical presentation and differential diagnosis are also covered. Laboratory studies and imaging studies like chest radiography are important for diagnosing complicated parapneumonic effusions or empyemas to allow for optimal management.
Common suppurative diseases of lung- Bronchiectasis...!Sharmin Susiwala
Bronchiectasis is a condition characterized by irreversible dilation of part of the bronchial tree due to damage to elastic and muscular components, usually from acute or chronic infection. It requires both an infectious insult and impaired drainage or airway obstruction. Symptoms include daily cough and sputum production. Diagnosis involves chest imaging showing abnormal lung signs and high-resolution CT scanning. Treatment focuses on controlling infections with antibiotics and clearing secretions. Complications can include lung damage and recurrent pneumonia.
The document discusses lung abscess, including its definition, classification, microbiology, risk factors, pathophysiology, clinical features, diagnosis and treatment. A lung abscess is a microbial infection that causes necrosis of lung tissue, forming a cavity. It is usually caused by aspiration of oral anaerobic bacteria. Symptoms include cough, sputum production and fever. Diagnosis involves imaging showing a cavity with an air-fluid level. Treatment involves long-term antibiotics targeting the causative bacteria. Surgery is rarely needed except for failure of medical management or an underlying condition.
Lung abscess is a localized area of lung destruction caused by infection, typically by aspiration of oropharyngeal bacteria. It appears on imaging as a cavity containing air-fluid levels. The infection can start as necrotizing pneumonia that progresses to microabscesses and larger cavitary lesions over time. Risk factors include dental/sinus infections, impaired swallowing, or pre-existing lung disease. Treatment involves antibiotics targeting common aerobic and anaerobic bacteria. Therapy typically lasts 4-6 weeks until imaging shows resolution, though surgery may be needed for large or resistant abscesses. Complications can include empyema, bronchopleural fistula, or distant infections if not properly treated.
This document discusses pneumonia and the silhouette sign. It begins by defining pneumonia and describing the most common radiographic patterns, including lobar, bronchopneumonia, and interstitial pneumonia. It then examines specific pathogens that can cause pneumonia such as Streptococcus pneumoniae, Klebsiella, Staphylococcus aureus, and Mycoplasma. The document also discusses opportunistic infections. Next, it introduces the silhouette sign and how observing which structures a lung opacity obscures can indicate its location. Finally, it reviews some common pitfalls when using the silhouette sign and summarizes key points about interpreting chest radiographs for pneumonia.
The document discusses the anatomy, physiology, and common diseases of the pleura. It begins by describing the layers of the pleura, the pleural space, and fluid. Functions include allowing lung movement during respiration and acting as a buffer for fluid. Common pleural diseases are then examined in more detail, including pleural effusions, pneumothorax, and empyema. Causes, characteristics, diagnosis, and treatment approaches are summarized for each condition.
A 22-year-old male presented with a 14-day history of fever and right-sided chest pain that worsened with deep breathing and coughing. On examination, he was febrile and tachycardic with dullness on percussion of the right infraaxillary area and diminished breath sounds. The document discusses various pleural diseases including pneumothorax, pleural effusion, and fibrous pleurisy. It outlines their etiologies, clinical features, investigations, and management. Primary spontaneous pneumothorax commonly affects young, thin males and smokers due to rupture of subpleural blebs. Pleural effusions can be transudative such as in heart failure or exudative including those
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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1. PLEURAL EMPYEMA
Department of Thoracic, General and Oncological Surgery
Medical University of Lodz
Head of the Department: Prof. Marian Brocki
Author of the lecture: Sławomir Jabłoński, MD
2. The inflamatory process in a preformed
anatomical space defined by the visceral
and parietal pleura
DEFINITION
Pleural empyema
thoracic empyema
or
3. Empyema is the presence of gross pus in the pleural
cavity; it consists of an effusion containing
polymorphonuclear leukocytes and fibrin.
The Greek philosopher, Aristotle, recognized empyema
and described the drainage of pus with incision and a
metal tube as early as 300 BC.
A parapneumonic process is defined as a pleural
effusion associated with pneumonia, lung abscess or
bronchiectasis.
Not all parapneumonic processes are empyemas.
Incidence & epidemiology
4. PLEURAL EMPYEMA (empyema pleurae)
Pleural empyema is a kind of exudative pleuritis caused
by microorganisms (bacteria, fungi, some protozoa) that infected
the pleural cavity.
Inflammation of organs or anatomical structures localized within
the chest and out its anatomical borders can caused a retention
of effusion in the pleural space (hydrothorax)
A reason for pleural effusions are also systemic diseases.
Initially sterile exudate can be resorbed by the pleura if a primary
disease is treated effectively.
The infection of the exudate causes its transformation into purulent
liquid that fills the pleural cavity and forms pleural empyema
(empyema pleurae).
5. PLEURAL EMPYEMA (empyema pleurae)
The presence of purulent liquid within the pleural cavity for several
Weeks leads to the formation of fibrin deposits on both the visceral
and parietal pleura and an imprisoning fibrothorax appears (fibrothorax).
Progressing empyema organization causes lung compression
and atelectasis, decreases lung volume and leads to inflammatory changes
within pulmonary parenchyma.
As a result ventilation and gas exchange disturbances are observed.
Within a fibrinopurulent capsule (membrana pyogenes) a collection
of pus is frequently present. However, septic liquid has no contact
with adjacent tissue well supplied with blood that’s why a clinical
presentation of empyema may be uncharacteristic and poorly expressed.
7. PLEURAL EMPYEMA (empyema pleurae)
CLINICAL CONDITIONS CAUSING LIQUID RETENTION
IN THE PLEURAL CAVITY :
TRANSUDATE - circulatory insufficiency, hepatic cirrhosis, nephrotic
syndrome, superior vena caval obstruction.
EXUDATE – malignancy, infection, pulmonary embolism, esophageal
perforation, pancreatitis, sarcoidosis, systemic diseases.
LYMPH (chylothorax) – trauma, surgery, malignancy, subclavian vein
thrombosis.
BLOOD (haemothorax) - trauma, malignancy
In a case when a liquid collected in the pleural space becomes infected
by virulent microorganisms it transforms into pus.
Pleural empyema can develop in any individual but it seems to be more
frequent in younger people in whom immune system is weakened.
8.
9. PLEURAL EMPYEMA (empyema pleurae)
The most frequent reason for pleural empyema are complications
of pneumonia (parapneumonic empyemas) and other diseases of tissues
adjacent to the pleural cavity.
An important etiological group for pleural empyema are complications
of surgical treatment of pulmonary, esophageal and mediastinal
pathologiesand frequent, repeated thoracocentesis for pleural effusion.
Lung resections with incomplete postoperative expansion of the lung
promote the formation of a cavity that creates good conditions for liquid
retention and its infection with bacteria from the bronchial tree, infected
postoperative wound or drains.
Complications of thoracic injuries and among them the infection of
non-evacuated posttraumatic hemothorax are significant etiological
factors of pleural empyema formation.
12. PLEURAL EMPYEMA (empyema pleurae)
PATHOPHYSIOLOGY – ways of infection :
DIRECT INFECTION through the chest wall as a result of
injury, thoracocentesis or surgical management (postoperative
pleural empyemas constitute approximately 25% of pleural
empyema cases)
CONTACT INFECTION – infection spreads from underlying
infected pulmonary parenchyma, lung abscess, bronchiectases,
subphrenic or perinephric abscess.
HEMATOGENOUS SPREAD
LYMPHOGENOUS SPREAD
13. PLEURAL EMPYEMA (empyema pleurae)
PATHOPHYSIOLOGY
PHASES OF PLEURAL EMPYEMA FORMATION :
Serous phase (exudative empyema): clear, straw-colored effusion
(pH>7.3, glucose concentration [GLU]>60 mg%, lactate
dehydrogenase activity [LDH] < 500 U/L )
Fibrinopurulent phase (fibrinopurulent empyema): effusion contains
large numbers of bacteria and polymorphonuclear granulocytes,
intensification of clinical signs and symptoms of inflammation,
deposition of fibrin on both the visceral and parietal pleura
( pH < 7,1, GLU < 40mg%, LDH > 1000 U/L)
Organizing empyema phase (organizing empyema) (fibrothorax) –
nonelastic, fibrinopurulent coat that imprisons the lung appears.
An empyema capsule contains pus.
17. PLEURAL EMPYEMA (empyema pleurae)
CLASSIFICATION OF PLEURAL EMPYEMAS :
Etiological classification:
specific (tuberculosis)
non-specific – non-specific bacterial infection
mixed
mycotic
Pathogenetic classification:
synpneumonic – empyema coexists with another lung
inflammation
metapneumonic – it develops when a primary inflammation has
already regressed
18. PLEURAL EMPYEMA (empyema pleurae)
CLASSIFICATION OF PLEURAL EMPYEMAS :
Size criterion:
non-localized empyemas – the whole pleural cavity is involved
localized (encapsulated) empyemas - ( unilocular or multilocular)
Duration and pathologic criterion :
acute empyema
chronic empyema
Jatrogenic empyemas:
empyemas with preserved
pulmonary parenchyma
empyemas after lung resection
(pneumonectomy)
- with bronchial fistula
- without bronchial fistula
19. PLEURAL EMPYEMA (empyema pleurae)
CLINICAL PRESENTATION:
ACUTE PHASE:
hectic fever
shivering
dyspnea
toxemia
chest pain
tachypnoë
asthenia
lack of appetite
weight loss
chest wall inflammation
(sometimes)
leucocytosis
anemia
expectoration of
purulent sputum
( if bronchial fistula
coexists)
CHRONIC PHASE:
subfebrile body
temperature
cachexia
low body mass
paroxysmal cough
dyspnea
contraction of
intercostal spaces
scoliosis
chest pain
attenuation of
respiratory murmur
dullness of sound
20. PLURAL EMPYEMA (empyema pleurae)
DIAGNOSIS :
characteristic clinical presentation
features of hydrothorax
in physical examination
chest X-ray
pleural ultrasonography
computed tomography
diagnostic thoracocentesis
( macroscopic features of liquid, positive bacterial cultures, glucose
concentration< 40 mg/dl, pH<7,0, LDH > 1000 U/L)
flexible bronchoscopy (useful in a case of bronchial fistula)
needle pleural biopsy
diagnostic videothoracoscopy
diagnostic thoracotomy
21. PLEURAL EMPYEMA (empyema pleurae)
ROENTGENOGRAPHIC APPEARANCE OF PLEURAL EMPYEMA :
opacification of the costophrenic angle compatible with pleural effusion
(the beginning of the disease)
roentgenographic features of lung compression caused by effusion
(Ellis-Damoiseau line)
the presence of an empyema capsule, on a lateral projection empyema
has a D-like shape.
the mediastinum is shifted to the contralateral side of the chest
pneumothorax with airfluid level (if bronchial fistula is present)
roentgenographic features of empyema and spherical opacification within
pulmonary parenchyma (empyema accompanied by lung abscess)
22.
23.
24. LUNG EMPYEMA (empyema pleurae)
TREATMENT :
The treatment of pleural empyema depends on its etiology, duration,
patient’s general state and concomitant diseases.
The general rules of empyema management are as follows: evacuation of
purulent liquid out of the pleural space, obliteration of the empyema sac and
augmentation of patient’s immune system.
The goals of treatment in pateints with pleural empyema are :
1. to save life
2. to elimintae the empyema
3. to reexpand the trapped lung
4. to restore the mobility of the chest wall and diaphragm
5. to return respiratory functionto normal
6. to eliminate complications and chronicity
7. to reduce the duration of hospital stay
(Mayo P, Saha SP, McElvein RB. Acute empyema in children treated
by open thoracotomy and decortication. Ann Thorac Surg. 1982;34:401-407)
Ubi pus evacua - ,,if you find pus remove it”
25. ACUTE EXUDATIVE EMPYEMA :
exudative empyema can be treated by aimed antibiotic therapy
and repeated needle aspirations of pleural effusion.
simultaneously coexistent pathologies are treated and nutritional
therapy is carried out.
intercostal tube drainage is usually a primary treatment for both
acute and chronic pleural empyema.
intrapleural antibiotic administration
TREATMENT :
26. PLEURAL EMPYEMA (empyema pleurae)
TREATMENT :
CHRONIC EMPYEMA :
suction intercostal tube drainage with interpleural antibiotic administration
irrigating pleural drainage
after 14 days a suction drainage can changed into an open drainage and
a patient can continue his or her therapy in an outpatient clinic.
interpleural administration of fibrinolytic agents in a case of encapsulated
empyema (Streptokinase or Streptodornase for 3-5 days)
videothoracoscopy with mechanical debridement of the pleural space ,
ablation of dividing walls within the empyema, partial decortication and
pleural drainage.
27. PLEURAL EMPYEMA (empyema pleurae)
SURGICAL MANAGEMENT :
thoracotomy and decortication- if by intercostal tube drainage lung
re-expansion isn’t achieved (decortication- a nonelastic fibrinopurulent coat
is removed from the underlying lung and the chest wall to make re-expansion
of the lung possible)
decortication and lung resection ( empyema is accompanied by lung abscesses,
lung mycosis or malignancy)
chest wall fenestration- a technique used in debilitated patients. An upside down
U-shaped skin incision is made to form a musculocutaneous flap. Short
fragments of 2 or 3 ribs are resected over the most dependent part of the
empyema sac. Then the flap (Eloesser flap) is introduced into the pleural space
and sutured together with the parietal pleura. A kind of a channel is formed
that enables effective pus drainage and repeated introduction of gauze saturated
with antiseptic agents. Such a management leads to gradual sterilization of the
pleural space and its healing by granulation.
28. SURGICAL MANAGEMENT:
in patients with pleural empyema after lung resection the ablation of the
empyema sac by a surgical reduction of its size is the main goal
(thoracoplasty, myoplasty, omentoplasty).
in patients with pleural empyema with bronchial fistula after
pneumonectomy - removal of the empyema sac (membrana pyogenes) and the
closure of the fistula (myoplastic procedures- bronchial fistula is covered with
a pedunculated muscle bundle) plus thoracoplasty.
Clagett procedure - chest wall is fenestrated. When the healing of the parietal
pleura by granulation appears the fenestration is closed and the pleural space is
sterilized by its filling throughout a drain with a solution of antibiotics selected on
the basis of bacterial cultures
Weder procedure- three successive thoracotomies are performed every 2-3 days.
During the first and the second thoracotomy fibrinopurulent empyema sac is
removed and gauze saturated with antibiotic solution is placed within the pleural
space. During the third thoracotomy gauze is removed.
39. Post lung resection empyema
Methods of tretment: - Muscle flap clousure
- Limited thoracoplasty
- Open window thoracostomy
Post lobctomy(0,01%-2,0%), post pneumonectomy (2%-16%),
residual space and air leak
40. The Clagett procedure -open-window thoracostomy
in patient with pleural empyema and bronchial
postpneumonectomy fistula (own meterial)
44. PLEURAL EMPYEMA (empyema pleurae)
PROGNOSIS :
Mortality in patients with pleural empyema ranges from 1% to 19%.
A reason for death in an acute phase of empyema is sepsis or other
complications of generalized infection.
Late deaths are caused by toxemia, respiratory insufficiency or
multiorgan failure.
In patients with concomitant diseases such as diabetes mellitus,
malnutrition, systemic diseases, malignancy and alcoholism mortality
reaches 40%.