What are the symptoms of pleural empyema
A typical response to any form of suppuration and thatincluding pleural cavity is purulent-resorptive fever, based on factors lie festering, resorption - suction tissue debris and microorganisms, the loss factor. Different stages of the disease can highlight one or the other symptoms caused by the predominant factor at the moment, whether the loss or resorption, and perhaps both factors together. Go to the purulent-resorptive depletion occurs gradually, without clear clinical boundaries, sometimes slowed, sometimes quickly - within a few days, especially when massive putrid processes gangrenous type exciting light and the pleural cavity together.
It is clear that the degree of purulent resorptivefever, as well as intoxication can vary, ranging from mild and ending with heavier and heavier. Clinical distinction and differential diagnosis difficult.
Sometimes, a few days after the crisispneumonia, empyema as long as the majority of it is the source of them reappear chills, flank pain, dyspnea, fever. Perhaps it is a recurrence of lung inflammation. Soon, however, after 3-5 days of ongoing chills, revealed a distinct blunting nerkutornogo sound in the bottom half of the chest, often from behind, on the shoulder and paravertebral lines. Weakened voice trembling and breathing. In a word, showing signs of accumulating in plevralpoy cavity fluid. In other cases, the picture is played secretly. It would seem that safely transferred inflammation of the lung does not bring the expected recovery on the contrary, gradually intensified shortness of breath, chilling, sometimes there are stabbing pains in his side, an increase in temperature. Another option flow can be parallel development of pneumonia and purulent exudate in the pleural cavity.
At the clinic, patients come much later. By this time, manifest symptoms of suppuration, both general and local plan. Face of patients with empyema has the characteristics of general inflammation in the body: a light blush covering his cheeks, rather suggests the inflammatory focus, rather than a favorable course of the disease. Some wariness in his eyes, nostrils and fluctuating involved in the act of breathing muscles of the neck complete the look of suffering. Of course, this is not always the case. Small empyema - limited, I-II degree, almost no effect on the appearance.
Progressive purulent-resorptive feverIt is turning into exhaustion, regardless of the volumeempyema cavity, but with the concomitant destruction of lung tissue - "empyema with pulmonary tissue destruction" - significantly changing the face of the patient. Detachment in the sight of pasty face, sunken cheeks, contoured neck veins, the breath of his mouth, the dried, almost lacquered language, sometimes fetid breath complete the picture. In later periods, when in the foreground loss factor, and symptoms of intoxication are smoothed out, the patient looks like a hard starving.
Dry, pellagroidnaya skin, pale skin, in the form of fingersdrum sticks and nails, as the hour glass, meet with great regularity. Bilateral empiemnye processes or one-sided with progressive collapse of lung tissue often manifest cyanosis, occasionally hemorrhagic diathesis in the form of polymorphic ecchymosis front and side surfaces of the legs, torso. Old doctor was known symptom of Bo, indicating the progressive course of severe disease. The essence of the symptom is the presence of the cross, going through the entire nail grooves and strips emerging from the nail bed, and moving to the free edge of the nail as growth. It must be said that many times, seeing this kind of deformation of the nail plate ,, but not realizing their substance, we only retrospectively linked this symptom with severe purulent-resorptive exhaustion.
Body temperature - One of the most important signs of pyo-resorptiveprocesses. During the initial period and thereafter, in the absence of effective treatment, the reaction temperature can be considerable, flowing through remitting type in irregular waves with a tendency to decrease in the morning is not reached, however, the normal or subnormal digits. In the transition to a purulent depletion is an inversion of the temperature curve. Morning and evening body temperature fluctuates in small limits on the level of low grade (37,5-38 ° C) or that prognostically bad, normal values with minor to semi-degree scale.
loss of flesh occurs relatively slowly, especiallyat the expense of fat depots, dwindling during intoxication and hyperthermia. As protein loss, drop in body weight increases, creates dissonance with due weight.
Swelling of the lower extremities, sometimes considerable, and occasionally ascites inherentextreme, on the verge of depletion, forms of purulent-resorptive fever. In these cases, patients could be observed with "dry", "skeletal" feet. Significant swelling shins quite frequently when empyema with the destruction of lung tissue. Its origin is probably gipoproteinemicheskoe, which in turn is due to hypovolemia. Of course, it is possible, and the genesis of heart, but rational parenteral nutrition, overlapping losses, leveling resorptive factor pretty quickly led to the disappearance of edema. Selectivity localization and constant parallelism with hypo- and dysproteinemia are compounded by dysfunction of the system protein - water - electrolytes, we confirmed our thoughts about volemic genesis of edema. By IV Davydov, swelling accompanied by purulent resorptive fever in 8-10%, this percentage rises to 70 in purulent exhaustion.
Headache should always be the subject of carefulresearch - a full neurological, radiographic (x-ray of the skull) and electroencephalogram. Twice cause headaches appeared metastatic brain abscess and both times - in patients with pleural empyema with the destruction of lung tissue. Chest pain usually caused by changes in the parietal pleura, but the destruction of large pulmonary structures become visceral in nature. Trying to spare half of the breast concerned, patients take a forced situation, bending and trying to ensure peace. This selective position often directly indicates the localization process, allowing to conduct directed stetakustichesky search. The intensity of pain is different, however, when the cavity formed, perhaps, never seen so intolerant, burdensome pain, which would require the use of analgesics. Empyema often accompanied by pain when breathing, empyema with the destruction of lung tissue - spontaneous, aching. The outer appearance of the chest is quite typical. There is a retraction of intercostal spaces and narrowing with fibrous thickening it.
The blade is slightly raised up, falling behind atbreath compared with its opposite making lame like. Painful feeling can mention some point resistance and soft tissue swelling resembles. In such cases, you can not jump to conclusions. Flat testovatoy swelling, covered with intact skin, which occupies the space of a few intercostal space on the midclavicular or axillary lines ,. The swelling increases in size when coughing and strengthened exhale. Only later appears flushing of the skin, indicating purulent melting of all layers of the chest wall.
Characteristically fainting voice tremor. Slowly perdvigaya hand up, you can identifyborder empyema cavity, identify it and confirming percussion and auscultation, go to the X-ray examination. Percussion dullness detectable as we move to the upper boundary of the cavity receives a clear tone, turning into tympanic sound - a sign of Skoda. Auscultation dominant symptom of weakening of normal vesicular breathing, receiving the bronchial character. Useful bronhofoniya, the combination of which with impaired breathing gets additional diagnostic value. Variegated wheezing often accompanied by pleural empyema with the destruction of lung tissue.
These clinical features inherentfester lung and pleura, would be incomplete if you do not bring a breakthrough clinic pulmonary abscess into the pleural cavity. The classical description of SI Spasokukotsky not lost its vitality.
Now they have a place given three clinical forms:
- Acute, rapidly flowing;
The acute form. Picture cardiac collapse, suddenly appeared boxed sound when percussion over dulling. Not excluded the growing signs of pneumothorax and lung collapse.
Soft form. Breakthrough abscess in a closed, encystedspace. Mild pain, inversion of the physical signs. The deterioration of the patient with some form of destruction of lung tissue must always be imperative impetus to the search for signs emerged pneumoempyema.
Deleted shape. The moment of penetration into the pleura is difficult to grasp. Only a careful questioning of the patient will allow to capture the nuances of state, and then document them X-rays.
Giant lung abscess, visceral pleuraover which the increment to the parietal and lost structural, so that all together is a single whole, can be regarded as empyema, although it does not correspond to the classical description of it. Pus, breaking the skin by type perforans, in the presence of the draining bronchus dangerous total subcutaneous emphysema, often creates the preconditions for extensive suppuratsii.
However, it may be the reverse clinical picture. Empyema, which arose as a result of already disappeared mikrodestruktsii lung tissue breaks in the large bronchi. Purulent, foul-smelling sputum is often "full mouth" will be in a similar situation leading symptom in mild form of education pneumoempyema. Not rare prodrome: ephemeral hemoptysis, does not cause fear in the patient and not attracted the attention of a doctor. Diagnosis of broncho-pleural fistula (18.8% according to the observations) is relatively easy, where the diameter of the bronchus is significant. It is necessary to put the patient on a healthy side, sometimes on the back or stomach, in short, to pick up the drainage of empyema cavity position as cough reflex immediately gives to know about the existence of the communication with the bronchial system. The characteristic phlegm approve the assumption. However, a definitive diagnosis of a topic and fistula require verification, and hence a special, including methods bronchoscopy studies.
The revealed pleural effusion alwaysshould be an occasion for reflection, the foundation of which is the result of the diagnostic puncture. Place determined by its clinical and radiological examination. Catch transition serous effusion purulent quite difficult, but in this recipe for success in the treatment of empyema.
Changes in white blood
WBC with pleural empyema, as wellAs with any suppurative process is changing. One of the striking features - neutrophilia. It increases with the intensification of purulent-resorptive fever, varying the weight of the patients. Neutrocytosis indicates the severity of suppurative process, and moderate leukocytosis makes you think about the reduced ability of hematopoietic system. Absolute lymphocytosis in the first case and the second lymphopenia accompanied by empyema with lung destruction Kani. Lymphocytosis as a prognostic symptom difficult of interpretation, but lymphopenia is clearly unfavorable. If monocytosis can be regarded as a sign of irritation of the reticuloendothelial system, monocytopenia is unfavorable prognostic symptom.
On the basis of leukocyte profile analysis can beif you do not distinguish between forms of empyema, referring to the destruction of lung tissue and the lack of it, in any case, changes in white blood tipizm inherent gravity of the suppurative process.