Empyema - purulent inflammation of the pleura - is the result of a breakthrough in the pleural cavity of the abscess, infection serous exudate with inflammation of the lung or chest injuries.
Microbial flora with empyema may bediverse: pneumococci, streptococci, staphylococci. At the break of an abscess communicating with the bronchi, arises pneumoempyema - accumulation of pus in the pleural space and air. pleural empyema may be encysted and spilled.
When pleural empyema signs of severeintoxication: high fever, shortness of breath, tachycardia, cyanosis of the mucous membranes, chest pain. Reveals lag while breathing the affected side, percussion - blunting of pulmonary sound on auscultation - reduced air and voice tremor. At the moment of breakthrough abscess into the pleural cavity of the shock occurs.
When X-ray transparency of the lung fieldslowered, and with a significant accumulation of fluid observed full blackout shade and displacement of the heart in a healthy way. On the affected side of the diaphragm and pleural shadow sine not detected.
Empyema may be complicated by an abscess break out through the chest wall, ribs osteomyelitis, bronchopleural fistulas.
The diagnosis of pleural empyema is established on the basis of clinical and radiological survey. In case of doubt, it is a pleural puncture with the contents of the study.
At the beginning of the disease prescribe massiveantibiotic therapy. Antibiotics combined with sulfanilamidnymi drugs. Showing repeated puncture of the pleural cavity with the removal of content and the introduction of antibiotics. If the puncture is not possible to achieve a cure, introduced a permanent drain through a small incision in the seventh and ninth intercostal space. Pus remove active aspiration or create a passive outflow. Drainage is removed after termination of discharge of pus. A drain may be washed pleural cavity with antiseptics or antibiotics solutions. Constant aspiration is needed in patients with piopnevmotraksom to remove air and pus.
At long current empyema, not givingconservative treatment methods, resort to surgical intervention (opening of the pleural cavity, the removal of pus and purulent focus tamponade). In the case of residual septic cavities with thick walls made of connective tissue shows a pleurectomy or thoracoplasty. This interference leads to a retraction of the chest wall, contact between the parietal and visceral pleura, and their fusion of liquidation of the residual cavity.