Empyema and pleural effusion

Question 1

what is empyema?

Answer 1

it’s a collection of pus in the pleural space, usually after pneumonia

Question 2

what is the most common causative organism of empyema?

Answer 2

streptococcus pneumoniae

Question 3

what are 2 types of pleural effusion?

Answer 3

transudate
exudate

Question 3

what are the 4 presentations of emypema?

c+b , pcp, p+r, rb+e

Answer 3

• cough and breathlessness
• pleuritic chest pain
• prolong and recurrent fever after pneumonia treatment
• reduced breathing and expansion

Question 4

what is pleural effusion?

Answer 4

it is a collection of fluid in pleural space due to production and absorption imbalance

Question 5

what are the 3 presentations of pleural effusion?

b, pcp, rb

Answer 5

• breathlessness
• pleuritic chest pain
• reduced breathing

Question 6

what is transudate pleural effusion?

Answer 6

• non-inflammatory fluid that shifts in pleural space
• low protein content <3g/dL (<35g/L)

Question 7

what is exudate pleural effusion?

Answer 7

• accumulation of inflammatory fluid in pleural space
• high protein content >3g/dL (>35g/l)

Question 7

what are the 4 causes of transudate pleural effusion?

hf, h, lc, ns

Answer 7

• heart failure
• hypoalbuminaemia
• liver cirrhosis (scarring)
• nephrotic syndrome

Question 8

what are 4 causes of exudate pleural effusion?

m, p, p, pe

Answer 8

• malignancy
• pancreatitis
• pneumonia
• pulmonary embolism

Question 9

what do you look for in the blood tests?

Answer 9

-full blood count
raised white blood cells

raised inflammatory marker
c - reactive protein

Question 10

what is the gold standard?

Answer 10

thoracic ultrasound and pleural fluid aspirate

Question 10

what will you find in a CT scan of the thorax?

Answer 10

empyema shows thickened pleura compared to effusion

Question 11

What does chest x ray show?

Answer 11

complex effusion

Question 12

what does effusion and emypema aspirate analysis do?

Answer 12

determines pH, fluid type and casue of effusion

Question 13

what are the results for the effusion and emypema?

Answer 13

simple parapneumonic effusion
pH >7.2

complicated parapneumonic effusion pH <7.2

empyema thoracis
frank pus and positive bacterial culture

Question 14

what does the lights criteria do?

Answer 14

differentiates between transudate and exudate pleural effusion

Question 15

what is the lights criteria for exudative pleural effusion?

Answer 15

effusion protein/ serum protein ratio >0.5

effusion LDH/ serum LDH ratio >0.6

effusion LDH level > 2/3 the upper limit of the lab’s reference rage of serum LDH

Question 16

what is the treatment for simple parapneumonic effusion pH>7.2?

Answer 16

• treat the underlying cause
• oral antibiotics

Question 17

what is the treatment for complicated parapneumonic effusion pH <7.2?

Answer 17

if thickened pleura on CT scan or positive culture
- treat the underlying cause
- IV antibiotics
- chest drainage

Question 18

what is the treatment for empyema?

Answer 18

• antibiotics for 2-6 weeks
• chest drain insertion if fluid pH <7.2
• if there is NO improvement: VATS

Question 19

What are the indications of chest drainage for parapneumonic effusion?

Answer 19

low pH<7.2
frank pus
positive bacterial culture
severely impacted breathing