Pleural Empyema

Question 1

What is pleural empyema?

Answer 1

Accumulation of pus in the pleural cavity

This condition often arises as a complication of pneumonia.

Question 2

What is the most common etiology of pleural empyema?

Answer 2

Pneumonia

Other causes can include infected hemothorax, ruptured lung abscess, esophageal tear, and thoracic trauma.

Question 3

List less common causes of pleural empyema.

Answer 3

• Infected hemothorax
• Ruptured lung abscess
• Esophageal tear
• Thoracic trauma

These causes can lead to the accumulation of pus in the pleural cavity.

Question 4

What is Stage I of pleural empyema classification?

Answer 4

Exudative: accumulation of fluid and pus

This stage marks the initial phase of pleural empyema.

Question 5

What occurs in Stage II of pleural empyema?

Answer 5

Fibrinopurulent: aggregation of fibrin deposits that form septations and pockets

This stage indicates a progression in the disease process.

Question 6

Describe Stage III of pleural empyema.

Answer 6

Organizing: formation of thick fibrous peel on pleural surface that restricts lung movement

This stage can significantly impact respiratory function.

Question 7

What are common clinical features of pleural empyema?

Answer 7

• Fever
• Chills
• Cough
• Chest discomfort

These symptoms can help in the clinical diagnosis of the condition.

Question 8

What is pleural effusion?

Answer 8

Accumulation of fluid in the pleural space

Can be classified as exudative or transudative based on the cause

Question 9

What does the ‘split pleura sign’ indicate?

Answer 9

Thickening of visceral and parietal pleura

Often seen in empyema cases

Question 10

What are the characteristics of exudative effusion?

Answer 10

Grossly purulent appearance, positive Gram stain and bacterial culture, pH < 7.2, low glucose < 30-60 mg/dL

Indicates infection or malignancy

Question 11

What is the first-line treatment for community-acquired pleural empyema?

Answer 11

Combination therapy with a parenteral second- or third-generation cephalosporin plus anaerobic coverage

Examples include ceftriaxone with metronidazole or clindamycin

Question 12

What should be added to the treatment of hospital-acquired pleural empyema?

Answer 12

MRSA and pseudomonal coverage

Use vancomycin plus cefepime and metronidazole, piperacillin-tazobactam, or meropenem

Question 13

What is the recommended treatment for Stage I empyema?

Answer 13

Chest tube (thoracostomy) and consider intrapleural administration of fibrinolytic agents

Focuses on fluid removal

Question 14

What is the second-line treatment for Stage II or mixed Stage II/III empyema?

Answer 14

VATS (Video-Assisted Thoracoscopic Surgery) debridement if chest-tube drainage is ineffective

First-line treatment remains chest tube drainage

Question 15

True or False: Aminoglycoside antibiotics are recommended for pleural empyema treatment.

Answer 15

False

Poor pleural bioavailability makes them ineffective

Question 16

Fill in the blank: The treatment for Stage III empyema includes _______.

Answer 16

VATS debridement and pleurectomy with lung decortication via open thoracotomy

Involves more invasive procedures to manage advanced disease

Question 17

What is the role of empiric antibiotic therapy in pleural empyema treatment?

Answer 17

All patients should receive empiric antibiotics adjusted to their needs, local resistance patterns, and institutional guidelines

Essential for managing infections effectively

Question 18

Management of empyema ?

Answer 18

Question 19

What is pleural effusion?

Answer 19

Accumulation of fluid in the pleural cavity.

This can be categorized into different types based on the nature of the fluid.

Question 20

What is the difference between parapneumonic effusion and empyema?

Answer 20

Parapneumonic effusion is an accumulation of exudative fluid; empyema is an accumulation of pus in the pleural cavity.

Both conditions are related to pneumonia.

Question 21

What is the most common etiology of parapneumonic effusion?

Answer 21

Pneumonia.

Other causes can include infected hemothorax, ruptured lung abscess, esophageal tear, and thoracic trauma.

Question 22

What characterizes uncomplicated parapneumonic effusion?

Answer 22

Exudative effusion without direct bacterial invasion.

It is often associated with mild symptoms.

Question 23

What characterizes complicated parapneumonic effusion?

Answer 23

Exudative effusion with bacterial invasion

This condition may lead to further complications if untreated.\

Empyema = bacterial colonisation

Question 24

What are the clinical features of pleural empyema?

Answer 24

• Fever
• Chills
• Cough
• Chest discomfort

These symptoms indicate a more severe infection.

Question 25

What imaging techniques are used to diagnose parapneumonic effusion?

Answer 25

* Chest x-ray ## Footnote Imaging helps to visualize the fluid accumulation.

Question 26

What is the pH of pleural fluid in uncomplicated parapneumonic effusion?

Answer 26

pH > 7.2. ## Footnote Indicates less severe infection compared to complicated cases.

Question 27

What is the pH of pleural fluid in complicated parapneumonic effusion or empyema?

Answer 27

pH < 7.2. ## Footnote This indicates a more severe infection with potential bacterial activity.

Question 28

What is the glucose level in pleural fluid for uncomplicated parapneumonic effusion?

Answer 28

Normal or low. ## Footnote Glucose levels can help differentiate between types of effusion.

Question 29

What is the glucose level in pleural fluid for complicated parapneumonic effusion or empyema?

Answer 29

Low. ## Footnote Low glucose levels are indicative of infection and inflammatory processes.

Question 30

What is a common treatment for parapneumonic effusion?

Answer 30

Systemic antibiotic treatment. ## Footnote This helps prevent progression to complicated effusion and empyema.

Question 31

What procedure is often performed for empyema treatment?

Answer 31

Chest tube (thoracostomy). ## Footnote This allows for drainage of pus and fluid from the pleural cavity.