Can empyema be cured?

Empyema is a relatively common disease in daily life. It is a bacterial infection caused by bacteria invading the human pleural cavity, causing suppuration in the pleural cavity. Empyema is divided into two types, acute and chronic. Empyema is very harmful to the human body and can easily lead to some complications. It can be cured with timely treatment.

Can empyema be cured?

Abscess chest is an acute suppurative pleural cavity disease caused by bacterial infection. It can be cured with the use of large amounts of antibiotics.

Causes

Pleural cavity purulent infection resulting in accumulation of pus in the pleural cavity. Pathogens can enter the pleural cavity through the following routes:

1. Lung inflammation, especially pneumonia close to the visceral pleura, can spread directly to the pleural cavity.

2. Lung abscess or combined cavity ruptures directly into the pleural cavity.

3. Trauma to the chest wall, lungs, or esophagus.

4. Mediastinal infection spreads to the pleural cavity, such as spontaneous rupture or perforation of the esophagus.

5. Subphrenic abscess spreads to the pleural cavity through lymphatic vessels.

6. Pathogenic bacteria of bacteremia or sepsis enter the pleural cavity through the blood circulation.

7. Nosocomial infection, such as contamination caused by thoracentesis or surgery, leading to empyema.

Before the advent of antibiotics, Pneumococcus, Streptococcus and Staphylococcus were the main pathogens of empyema. Now the more common pathogens are Staphylococcus and certain Gram-negative bacilli, such as Klebsiella, Escherichia coli, Pseudomonas aeruginosa, etc. It can also be caused by special pathogenic microorganisms such as Mycobacterium tuberculosis, ameba and actinomycetes.

Clinical manifestations

1. Medical history and symptoms

When empyema occurs secondary to lung infection, there is usually a history of acute pneumonia. When the fever and other symptoms caused by pneumonia gradually improve, the patient will again experience symptoms such as high fever, chest pain, sweating, poor appetite and increased cough. If the acute empyema is caused by rupture of lung abscess, there are often sudden severe chest pain, high fever and difficulty breathing, and sometimes cyanosis and shock symptoms. If a bronchopleural fistula occurs, the patient may suddenly cough up a large amount of purulent sputum, sometimes with blood.

Chronic empyema is an acute empyema that has not been cured in time for 6 to 8 weeks and has turned into a chronic stage. Due to the formation of thicker fibrous plates, the absorption of toxins in the pus is reduced. Clinically, the symptoms of acute poisoning are milder, mainly low fever, fatigue, weight loss, anemia, low protein, etc. caused by chronic poisoning symptoms and long-term chronic consumption, as well as chronic cough, sputum, shortness of breath and chest pain, and difficulty breathing during activities.

2. Physical signs

Patients in the acute stage of empyema have an acute facial expression, are sometimes unable to lie flat, have weakened respiratory movements on the affected side, have dull and solid percussion sounds, and have significantly reduced or disappeared breath sounds on auscultation.

In the chronic stage of empyema, the chest wall on the affected side collapses, respiratory movements weaken, the spine bends toward the affected side, the trachea and mediastinum shift toward the affected side, percussion is dull or solid, and breath sounds on auscultation are significantly reduced or disappear. If bronchopleural fistula is present, the cough may worsen when the patient lies on the healthy side. Patients with long-term disease may have clubbing of fingers (toes).

examine

1. Blood test

The white blood cell count increases, the proportion of neutrophils increases, the nuclei shift to the left, and toxic granules can be seen. In the chronic stage, there is anemia, and hemoglobin and albumin are decreased.

2. Thoracentesis fluid test

Early exudate, then purulent, some with a foul odor, white blood cell count reaches (10-15)×109/L, mainly neutrophils; protein content>3g/dl, glucose<20mg/dl, smear staining microscopy can find pathogenic bacteria, culture can determine the pathogenic bacteria, and drug sensitivity test is used to guide treatment.

3. Chest X-ray

Early X-ray findings are similar to general pleural effusion signs or loculated pleural effusion, and there is air-fluid level when combined with bronchopleural fistula. In the chronic stage, there is pleural adhesion, reduction in the affected side chest volume, narrowing of the intercostal space, mediastinal shift, etc.

4. Pulmonary function test

The chronic stage is characterized by restrictive ventilation dysfunction and decreased vital capacity.

5. Sputum color examination

When bronchopleural fistula is suspected, 2 to 5 ml of 1% methylene blue can be injected into the chest cavity and the color of the coughed sputum can be observed to aid diagnosis.