扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 18. Pleura Diseases_Thoracic Empyema

EMPYEMATHORACIS

EMPYEMA THORACIS

: An empyemais a collection or gatheringof pus within a naturally existinganatomical cavity. For example, pleuralempyema is empyema of the pleural cavityIt must be differentiated from an abscesswhich is a collection of pus in a newlyformed cavity

• An empyemais a collection or gathering of pus within a naturally existing anatomical cavity. For example, pleural empyema is empyema of the pleural cavity. It must be differentiated from an abscess, which is a collection of pus in a newly formed cavity

: Epmyema thoracis is associated with highmortality ranging between 6% to 24%.. The incidence of empyema is increasing in bothchildren and adults; the cause of this surge isunknown.: Most cases of empyema complicate community-or hospital-acquired pneumonia but a proportionresults from iatrogenic causes or developswithout pneumonia

• Epmyema thoracis is associated with high mortality ranging between 6% to 24%. • The incidence of empyema is increasing in both children and adults; the cause of this surge is unknown. • Most cases of empyema complicate community￾or hospital-acquired pneumonia but a proportion results from iatrogenic causes or develops without pneumonia

DefinitionAccumulation of Pus in the Pleural cavity

Definition Accumulation of Pus in the Pleural cavity

EtiologyLung diseases:Pneumonia (the most common causeLung abscess.Subphrenic abscess.Post traumatic.latrogenic.Post-operativeBlood spread

Etiology • Lung diseases: Pneumonia (the most common cause) Lung abscess. • Subphrenic abscess. • Post traumatic. • Iatrogenic. • Post-operative. • Blood spread

OrganismsThe most common:: Staph.aureus .(90% of causes in infants &children): Strept.pneuomonie.H.influenzae

Organisms The most common: • Staph.aureus .(90% of causes in infants & children) • Strept.pneuomonie. • H.influenzae

Pathological Stages: Acute (exudative) stage:Pleura fills with thin fluid that shows oneor more of these criteria;Ph 1000 iu/dlProtein > 2.5 gm/dlSp.gravity >1.018

Pathological Stages • Acute (exudative) stage: Pleura fills with thin fluid that shows one or more of these criteria; Ph 1000 iu/dl Protein > 2.5 gm/dl Sp.gravity >1.018

Stages (cont.): Fibrinopurulent stage:Thick, Opaque fluid with positive culture(pus) and Deposition of thin fibrin layerover the pleura.Progressive loculation and formation ofpouches in the pleura

Stages (cont.) • Fibrinopurulent stage: Thick, Opaque fluid with positive culture (pus) and Deposition of thin fibrin layer over the pleura. Progressive loculation and formation of pouches in the pleura

Stages (cont.): Organizing Stage:Presence of very thick pus .Thick Inelaastic peel over both pleuraecausing entrapment of the lung

Stages (cont.) • Organizing Stage: Presence of very thick pus . Thick Inelaastic peel over both pleurae causing entrapment of the lung

Clinicalstages: Acute stage:within the first 2 weeks of the onsetChronic Stageafter 2 weeks or with the formation of thethick peel and loculations

Clinical stages • Acute stage : within the first 2 weeks of the onset. • Chronic Stage : after 2 weeks or with the formation of the thick peel and loculations