EMPYEMA THORACIS

1. EMPYEMA THORACIS Dr. Ashraf A. Esmat A.Prof.Cardio-thoracic surgery Cairo university

2. Definition Accumulation of Pus in the Pleural cavity. It comes from the greek word empyein ,which means :pus –producing (suppurates).

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

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

5. Pathological Stages • Acute (exudative) stage: Pleura fills with thin fluid that shows one or more of these criteria; Ph < 7.4 Glucose <40 mg/dl LDH> 1000 iu/dl Protein > 2.5 gm/dl Sp.gravity >1.018

6. 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.

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

8. 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.

9. Causes of chronicity: • Inadequate Tube Drainage. • Chronic pulmonary Disease( T.B. or Fungal Infection) • Immunosupressed patients. • Presence of Foreign body within the pleural space.

11. Symptoms & signs • Fever • Cough & Expectoration. • Pleuretic chest pain. • Easy fatiguability. • Loss of weight. • Night sweating.

12. Complications • Rupture into the lung; BronchoPleural fistula • Spread to the subcutaneous tissue; Empyema Niscitanes • Septicaemia & septic shock.

13. Investigations • Chest X-ray. • C-T scan. • Ultrasonography • Thoracentesis

16. Management • Control of the Infection process. • Drainage of pus form the pleura. • Obliteration of the space & complete Re-expansion of the Lung.

17. Drainage of Empyema • Intercostal tube thoracostomy. • Intrapleural instillation of streptokinase . • V.A.T.S. • Rib Resection Drainage. • Eloesser Flap .

18. Tube thoracostomy • Indications • Technique • When to remove • When to convert to open drainage

19. Intrapleural Streptokinase • Indications • Acute or fibrino purulent stage • Presence of loculations. • Incomplete drainage after tube insertion • Contraindications: • Chronic stage • Post-operative empyema • Empyema with BPF.

20. Technique • Streptokinase 25000 iu in 50 cc of 0.9% saline solution. • Clamp the tube for 6 hours. • Open the clamp and connect tube to suction

21. Video Assisted Thoracoscopy • Indications • Technique • Limitations • complications

22. Rib Resection Drainage • Indication • Technique • Limitations

24. Eloesser Flap Drainage • Indication. • Technique. • Advantage. • Disadvantage.

26. Reexpansion of the lung & obliteration of the space • Decortication. • Muscle Transposition. • Thoracoplasty.

27. Decortication • Indications. • Technique. • Postoperative care.

29. Thoracoplasty • Conventional alexander . • Tailoring thoracoplasty.

31. THANK YOU GOOD LUCK