Empyema Thoracic

Empyema Thoracic is the presence of pus in the cavity / pleural cavity.

Etiology of Empyema Thorasic
I. Derived from the lungs:

1. Pneumonia
2. Lung abscess
3. The existence of bronchopleural fistula
4. Bronchiectasis
5. Pulmonary Tuberculosis
6. Lung fungus.

II. From the extrapulmonary infection:

1. Trauma of the brain
2. Brain surgery
3. Torasentesis
4. Subfrenik abscess
5. Due to amoebic liver abscess.

Bacteriology

1. Staphylococcal piogenes, at all ages, often in children.
2. Piogenes streptococcus.
3. Gram-negative bacteria (Pseudomonas aeruginosa,, Klebsiela, Bakteroides, E. coli, Proteus mirabilis)
4. Anaerobic bacteria.

Pathophysiology Of Empyema Thorasic
Due to pyogenic bacteria invasion into the pleura arising acute inflammation, followed by the formation of serous exudates. With the number of PMN cells either living or dead, as well as increased levels of protein, the fluid becomes cloudy and thick. Fouled fibrin will form pockets of pus to localize it.

Clinical Symptoms
Clinical Course
Divided into 2 stages, namely: acute and chronic.
1. Acute empyema:

Symptoms are similar to pneumonia, high fever, pleuritic pain when the stage is left in a few weeks there will be toxemia, anemia and clubbing. If pus is not issued soon will arise fistula bronkopleura and "empyema necessitatis".

2. Chronic empyema:

Strict boundary between acute and chronic hard set, called chronic empyema when running more than 3 months.
Patients complain of a weak body, health, the patient looked back, pale and no clubbing.

Diagnosis
Physical examination.
Found signs of fluid, accompanied by the movement of sick hemitoraks reduced. There was a faint sound on percussion. On auscultation, breath sounds decreased until it disappears in the hemitoraks sick.

Chest X-ray photo.
On chest PA X-ray and lateral images obtained an image of "opacity" that indicate the presence of fluid with or without pulmonary abnormalities.
In the event of fibrotoraks, trachea and mediastinum attracted to the side of the hospital and also looked pleural thickening.

Sure Diagnosis
Pleural aspiration would indicate the presence of pus in the pleural cavity.
Furthermore, the pus is used as material for examination: cytology, bacteriology fungi, amoeba, done culture (culture) and sensitivity to antibiotics.

Management of Empyema Thoracic


Complications of Empyema Thoracic
Complication that often arises is: bronchopleural fistula.
Other complications that may occur are: shock, sepsis, congestive heart failure and otitis media.


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