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

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Presentation on theme: "EMPYEMA THORACIS Dr. Ashraf A. Esmat A.Prof.Cardio-thoracic surgery Cairo university."— Presentation transcript:

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) Pneumonia (the most common cause) Lung abscess. 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; 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. 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. Progressive loculation and formation of pouches in the pleura.

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

8 Clinical stages  Acute stage : within the first 2 weeks of the onset. within the first 2 weeks of the onset.  Chronic Stage : after 2 weeks or with the formation of the thick peel and loculations. 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.

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

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

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

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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 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

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

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

27 Decortication  Indications.  Technique.  Postoperative care.

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29 Thoracoplasty  Conventional alexander.  Tailoring thoracoplasty.

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31 THANK YOU GOOD LUCK


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