Chronic empyema

Overview of acute empyema 4 ~ 6 weeks of treatment Vomica not disappear, Pott flushing and a large sediment, suggest empyema has entered chronic phase. Cause pathogenesis one, causes chronic empyema is mainly due to : (a) Treatment of acute empyema timely inappropriate : Failure to timely diagnosis and inappropriate use of antibiotics and drug dose adjustment is not timely, no timely or pus aspiration or drainage of doing more because of the poor location of drainage, drainage tube is not Vomica the lowest position, drainage tubes are too small, too deep or location distorted, the lumen was necrotic tissue blockage caused poor drainage, Pott retention, chronic empyema. (2) after surgery if bronchopleural fistula or esophageal fistula, often pollutants and bacteria have entered the Vomica; Moreover, long-term expansion of lung failure, thoracic cavity with a long closure; chronic empyema perishable holdback. (3) adjacent to a pleural lesions chronic infection, such as subphrenic abscess, liver abscess, mediastinal abscess and osteomyelitis ribs and other source of infection has not been completely eliminated, the chronic empyema. (4) the chest with foreign bodies : If trauma, metal, bone slices, clothing and other debris retained foreign body in the chest caused secondary infection. (5) tuberculous empyema : some potential tuberculosis foci of ulceration, some tuberculosis Wearing chest wall, without effective anti-TB treatment, or because of pleural thickening and calcification, Antibuberculotic inaccessible lesions, chronic empyema, Such patients often associated with mixed infections. 2, pathophysiology of chronic empyema patients as a result of long-term infection, physical exertion, pleural thickening height, Special appearance of pleural thickening is particularly notable, some up to 2 cm above by fibrous connective tissue component, was gray and white, surface of the granulation tissue, a large quantity of Vomica necrotic tissue and cornea and segregation. Tuberculous empyema, will have cheese - like objects, as well as calcification. The visceral pleura and lung machine for the scar fiberboard constraints, the impact of the inflated lung, Vomica not closed. Diaphragmatic thickening due to the relatively fixed fiberboard, mediastinal by scar contraction traction to the affected displaced. Parietal pleura chest wall because of the fixed and fiberboard scar contraction enophthalmos, ribs got together, intercostal space narrowing, spine bent towards the contralateral, patients restrictive respiratory dysfunction, and some patients have clubbed fingers. Chronic empyema penetrating intercostal space with the dumbbell-shaped chest wall abscess formation, dressed as empyema, most of tuberculous empyema timely treatment complications. Chronic empyema patients, there will be hypoproteinemia and low hemoglobin disease, and liver and kidney dysfunction. The diagnosis of chronic empyema diagnosis is not difficult, most patients with acute empyema and formation history of chronic empyema process. But clinical patients to identify the systemic and local disease and chronic empyema reasons. Patients often have weight loss, anemia, reduced plasma protein, and different degrees of chronic systemic poisoning symptoms, such as fever, weakness, poor appetite. Visibility investigation body ipsilateral chest wall subsidence, thoracic breathing movement is restricted, intercostal space narrowing, and some patients with scoliosis, chest was real spontaneous delivery of voice auscultate breath sounds to reduce or disappear. Chest X-rays showed the affected pleural thickening, intercostal space narrowing, the ipsilateral mediastinal shift, pleural smaller, For metallic foreign bodies or calcification can be clearly shown that gas-liquid if a plane is illustrated in bronchopleural fistula or esophageal fistula, Vomica smaller or sinus exist only when injected lipiodol after being as lateral films, to show Vomica scope and availability of bronchopleural fistula; I swallowed or under fluoroscopic observation lipiodol any contrast agent into the chest, confirm the availability of fistula and esophageal fistula location and its size. If suspected bronchiectasis when bronchial angiography should be OK. Chronic empyema done without drainage, to be done pleural puncture, Wound cultures, in a clear empyema pathogenic strains. As the use of antibiotics, the culture may be negative. For bronchopleural fistula, to Intrapleural Meilan be available in the near future appeared to be expectorated in the sputum. Treatment of chronic empyema the treatment is to remove the cause of the disease, closed Vomica. The vast majority of patients will need surgery. In the course of treatment, we must take care of the body, to encourage patients to more activities and to strengthen the cardiovascular system. Nutritional supplement, plasma proteins, to correct anemia, as soon as their hemoglobin to 10 grams more, purulent sputum volume and reduce discharges to a minimum before they are allowed to take the larger operation. (1) to improve the drainage has been done but the drainage tube drainage, were closed down or drainage tube location is inappropriate, long-term impact of healing septic pond be reopened catheter drainage. If lung or nearby organs without lesions, empyema long stage of the disease, however, some patients can with the drainage improvements were cured. (2) pleural fibreboard stripping large areas of chronic empyema and removed their dirt, parietal pleura on the fiberboard, that the total resection Vomica wall, the lifting of coated fibers in lung tissue and the shackles of fixed right chest wall, lung re-expansion, Vomica disappeared, Thoracic breathing movements can be restored. But the timing of surgery is essential. For the course for too long, fibrous tissue has been submerged under pleural empyema wall so that not removed from the pleura on, surgical injury, bleeding, For secondary pulmonary fibrosis changes, postoperative pulmonary still not inflated, the surgeries will not have the anticipated effect. If widely destructive lung disease, tuberculosis or bronchiectasis empty when implementation is not appropriate pleural fibreboard endarterectomy, Therefore the application of lung surgery without significant changes, pleural thickening chronic empyema, early for the best effect. (3) within the pleural thoracic changing of (modified for Schede) Vomica lateral wall resection of the rib and thickening of the parietal pleura so that the remaining soft tissue of the chest wall (including rib membrane, intercostal nerves and blood vessels) with the collapse of Vomica right lateral cooperation, and the removal of visceral pleural surface of the granulation tissue to promote Vomica disappear if Vomica can use larger latissimus dorsi. serratus muscle pedicle flap filling. After placing drainage pipe and compression bandaging is to ensure that the results of operations of the important measures. The method is applicable to the pleural thickening in more serious cases. A pair of bronchopleural fistula tuberculosis or tuberculosis patients stainless steel wire suture fistula, reuse intercostal muscle strengthening, Then for pleural angioplasty within the thorax. (4) Extrapleural thoracic changing of : rib resection of the affected part and thickening of the visceral pleura fiberboard, so that the chest wall collapse Vomica closed, and for therapeutic purposes. Apply to pleural thickening is not too serious and has lung disease, such as active tuberculosis, coated or not stripping lung expansion of the disease. Thoracic forming, can cause deformities of the thoracic and ipsilateral lung function caused long-term damage, but the disease has long period, Pulmonary rehabilitation is not easy chronic empyema patients, after all, the radical to be effective. (5) pleural pneumonectomy as chronic empyema combined with the widespread and serious lung diseases, tuberculosis if empty, Bronchiectasis or high narrow, other surgical methods to cure. for the purposes of pleural pneumonectomy or pleural lobectomy indications. But such surgery is more complex, more bleeding, more dangerous, surgical indications should be strictly controlled.