Empyema and Decoration in Dubai

Empyema is inflammatory fluid and debris in the pleural space
Causes
Parapneumonic 70%

• Thoracic trauma (About 1–5% of cases of thoracic trauma lead to an empyema.) 
• Rupture of a lung abscess into the pleural space 
• Extension of a non-pleural-based infection (eg, mediastinitis, abdominal infection) 
• Esophageal tear 
• Iatrogenic introduction at the time of thoracic surgery 
• An indwelling catheter that is a nidus for infection

Pathophysiology

Exudative stage: protein-rich pleural fluid remains free-flowing. The number of neutrophils is rapidly increasing. Glucose and pH levels are normal. Drainage of the effusion and appropriate antimicrobial therapy are normally sufficient for treatment. 
Fibrinolytic stage: the viscosity of the pleural fluid increases. Coagulation factors are activated, and fibroblastic activity begins coating the pleural membrane with an adhesive meshwork. Glucose and pH levels are lower than normal. 
Organizing stage: Loculations form. Fibroblastic activity causes adherence to the visceral and parietal pleura. This activity may progress with the formation of pleural peels, in which the pleural layers are indistinguishable. Plus, which is a protein-rich fluid with inflammatory cells and debris, is present in the pleural space. Surgical intervention is often required at this stage 

Exudate stage:

• Protein-rich pleural fluid remains free-flowing.
• The number of neutrophils is rapidly increasing. 
• Glucose and pH levels are normal.
• Drainage of the effusion and appropriate antimicrobial therapy are normally sufficient for treatment

Fibrinolytic stage:

• The viscosity of the pleural fluid increases.
•  Coagulation factors are activated, and fibroblastic activity begins coating the pleural membrane with an adhesive meshwork.   
• Glucose and pH levels are lower than normal

Organizing stage:

Locations form.

• Fibroblastic activity causes adherence to the visceral and parietal pleura. This activity may progress with the formation of pleural peels, in which the pleural layers are indistinguishable. 
• Plus, which is a protein-rich fluid with inflammatory cells and debris, is present in the pleural space.
• Surgical intervention is often required at this stage

Presentation:

• Chills, high-grade fever, sweating, poor appetite, malaise, and cough
• Pleurisy and dyspnea
• Dullness to percussion and absent breath sounds  

Investigations:

• Standard 2-view chest radiography
• Ultrasonography 
• Chest CT

Intervention:

The main clinical decision is determining the appropriate time to drain the empyema
Laboratory indications for consideration of drainage are the following:

• PH < 7.20 
• Glucose  < 60 mg/dL 
• LDH  > 600 IU/L 
• Bacteria on Gram staining

Earliest stages:

• Thoracentesis
• Small-bore catheter
• Chest tube

Surgical interventions:

• Thoracoscopic debridement
• Video-assisted thoracoscopic surgery (VATS)
• Open thoracotomy for debridement
• Open surgical decortication

For top-notch thoracic surgery in Dubai, contact DRHC at +97142798200. We offer expert thoracic surgeons and comprehensive care.