This is a dangerous disease, which is accompanied by inflammation of the pleural sheets with a further accumulation of purulent masses in the pleural cavity. The disease requires immediate and comprehensive treatment, as otherwise a mass of complications may develop.
Brief information about the disease
Pleural empyema (ICD-10 assigned code J86 to this pathology) is a serious disease that is accompanied by inflammation of the pleura. Moreover, purulent masses begin to accumulate in the anatomical cavities (pleural cavity in this case).
According to statistics, men are faced with a similar disease three times more often than the fair sex. In most cases, empyema is a complication of other pathologies.
Causes of the development of the disease
The causes of empyema pleura may be different. If we are talking about the primary form of the disease, then the triggers in this case are the activity of pathogenic microorganisms, penetration into the cavity of blood or air, as well as a significant decrease in immunity. Primary empyema (in medicine, the disease also appears under the name “purulent pleurisy”) develops with:
- violation of the integrity of the chest against a background of injury or injury;
- previous surgical interventions, if they led to the formation of bronchial fistulas;
- thoracoabdominal injuries of the chest.
Secondary purulent pleurisy develops against the background of other pathologies. Their list is quite impressive:
- purulent processes in any organ system;
- inflammation of the lung tissue;
- the formation of an abscess in the tissues of the lung;
- oncological diseases of the respiratory system;
- spontaneous pneumothorax (violation of the integrity of the pleural cavity);
- inflammation of the appendix;
- peptic ulcer of the stomach and intestines;
- lung gangrene;
- cholecystitis;
- peritonitis;
- the formation of abscesses in the liver;
- sepsis;
- osteomyelitis;
- esophageal rupture;
- inflammation of the pericardium;
- inflammatory processes in the pancreas;
- infectious diseases of the respiratory system;
- tuberculosis.
It is worth noting that the disease can be caused by the activation of certain pathogenic microorganisms, in particular, pneumococci, streptococci, staphylococci, tubercle bacillus, pathogenic fungi and anaerobic bacteria. Pathogens can enter the tissues of the respiratory system along with the flow of blood and lymph from other organs.
Pleural empyema: classification
Today, there are many schemes that allow you to classify such a pathology, because you need to take into account a variety of factors.
For example, depending on the features and duration of the course, acute and chronic pleural empyema are distinguished. Symptoms of these forms may be different. For example, in an acute inflammatory-purulent process, signs of intoxication come to the fore, with the disease lasting less than a month. If we are talking about a chronic form of the disease, then the symptoms are more lubricated, but they worry the patient for a long time (more than 3 months).
Depending on the nature of the exudate, empyema can be purulent, specific, putrefactive and mixed. There is a closed (purulent masses are contained in the pleural cavity and do not go outside) and an open form of the disease (the formation of fistulas between the pleura and the lungs, bronchi, and skin through which exudate circulates) is observed.
Take into account the volume of pus formed:
- small empyema - the volume of purulent mass does not exceed 250 ml;
- the average at which the volume of exudate is 500-1000 ml;
- large empyema - there is an accumulation of a large amount of pus (more than 1 liter).
Depending on the location of the focus, the pathological process can be either one-sided or two-sided. Of course, all these characteristics are important for creating an effective treatment regimen.
Stages of the development of the disease
To date, there are three stages of development of this pathology.
- The first phase is serous. Serous effusion begins to accumulate in the pleural cavity. If at this stage the patient was not provided with appropriate assistance, then in the serous fluid, reproduction of pyogenic flora begins actively.
- The second stage is fibrous-serous. Exudate in the pleural cavity becomes cloudy, which is associated with the activity of pathogenic bacteria. Fibrinous plaque forms on the surface of the parietal and visceral sheets. Gradually, commissures form between the sheets. Thick pus builds up between the leaves.
- The third stage is fibrous. At this stage, the formation of dense adhesions that constrain the lung is observed. Since lung tissue does not function normally, it also undergoes fibrotic processes.
Symptoms of pathology
The acute form of empyema of the lung is accompanied by very characteristic symptoms.
- The patient's body temperature rises.
- There are other symptoms of intoxication, in particular, chills, pain and aching muscles, drowsiness, weakness, sweating.
- A characteristic sign of empyema is coughing. At first it is dry, but gradually becomes productive. When coughing, sputum is released in a greenish-yellow, gray or rye color. Often, the discharge has an extremely unpleasant odor.
- Shortness of breath also belongs to the list of symptoms - at first it appears only during physical activity, but then the patient is disturbed and at rest.
- As the pathology progresses, pain in the sternum appears, which intensifies on exhalation and inhalation.
- A change in the work of the respiratory system also affects the functioning of the heart, causing one or another disturbance in its rhythm.
- Patients complain of constant weakness, fatigue, decreased performance, a feeling of weakness, and lack of appetite.
- Disturbances of the respiratory system are sometimes accompanied by some external symptoms. For example, the skin on the lips and fingertips of a patient acquires a bluish tint.
According to statistics, in about 15% of cases, the process goes into a chronic form. In this case, the clinical picture looks different. Symptoms of intoxication are absent, as well as an increase in temperature. The cough bothers the patient constantly. Patients also complain of recurring headaches. If untreated, various chest deformities develop, as well as scoliosis, which is associated with some compensatory mechanisms.
Possible complications
According to statistics, the right treatment helps to cope with pleural empyema. Complications, however, are possible. Their list is as follows:
- degenerative changes in the kidneys;
- serious damage to the myocardium, kidneys and some other organs;
- blood clots, clogged vessels;
- multiple organ failure;
- the formation of bronchopleural fistulas;
- the development of amyloidosis;
- thromboembolism of the pulmonary artery associated with thrombosis (requires emergency surgical intervention, as otherwise there is a high probability of death).
As you can see, the consequences of the disease are very dangerous. That is why in no case should you ignore the symptoms of the disease and refuse the help of a qualified specialist.
Diagnostic measures
Diagnosis of pleural empyema is extremely important. The doctor is faced with the task of not only confirming the presence of pyothorax, then also determining the nature of the pathological process, the degree of its spread, and the causes.
- To begin with, an anamnesis is collected, a patient's medical data are examined. With an external examination of the chest, he may notice one or another degree of deformation, swelling or smoothing of the intercostal space. If we are talking about chronic pleural empyema, then the patient has scoliosis. Very characteristic is the omission of the shoulder and the protrusion of the shoulder blades from the affected side.
- Auscultation is mandatory.
- In the future, the patient is sent to various studies. Laboratory tests of blood and urine are mandatory, during which you can determine the presence of an inflammatory process. Microscopic examination of sputum and aspirated fluid.
- Exudate samples are used for bacterial culture. This procedure allows you to determine the genus and type of pathogen, to check the degree of its sensitivity to certain drugs.
- Informative are fluoroscopy and radiography of the lungs. In the pictures, the affected areas are darkened.
- Pleurofistulography is a procedure that helps detect fistulas (if any).
- There is also pleural puncture and ultrasonography of the pleural cavity.
- Sometimes the patient is additionally sent for magnetic resonance and / or computed tomography. Such studies help the doctor to evaluate the structure and functioning of the lungs, detect the accumulation of exudate and evaluate its volume, diagnose the presence of certain complications.
Based on the data obtained, the doctor selects the appropriate drugs and draws up an effective treatment regimen.
Therapeutic treatment
Treatment of pleural empyema primarily involves the removal of purulent masses - this can be done both during a puncture and through a full opening of the chest (this method is resorted to only as a last resort).
Since the formation of purulent exudate in one way or another is associated with the activity of pathogenic microorganisms, antibiotics of a wide spectrum of effects in the form of tablets are necessarily introduced into the treatment regimen. Effective are drugs from the group of aminoglycosides, cephalosporins, fluoroquinolones. In addition, sometimes antibacterial agents are injected directly into the pleural cavity to achieve maximum results.
Sometimes patients are prescribed transfusions of protein preparations, for example, special hydrolysates, albumin, and purified blood plasma. Additionally, glucose and electrolyte solutions are introduced that help restore the body.
Immunomodulatory therapy is mandatory, as well as taking vitamin complexes - this helps strengthen the immune system, which, in turn, contributes to the rapid recovery of the body. Symptomatic treatment is also carried out . For example, with severe fever, antipyretic and non-steroidal anti-inflammatory drugs are used.
After the symptoms of empyema become less pronounced, physiotherapy is recommended for patients. Special breathing exercises help strengthen intercostal muscles, normalize lung function, and saturate the body with oxygen. A therapeutic massage will also be useful, which also helps cleanse the lungs of sputum, improve the well-being of the body. Additionally, therapeutic exercises are held. Good results are given and ultrasound therapy. During rehabilitation, doctors recommend that patients undergo rehabilitation spa treatment.
When is surgery necessary?
Unfortunately, sometimes only surgery helps to cope with the disease. Pleural empyema, which is characterized by a chronic course and the accumulation of a large amount of pus, requires surgical intervention. Such methods of therapy can relieve intoxication symptoms, eliminate fistulas and cavities, straighten the affected lung, remove purulent exudate and sanitize the pleural cavity.
Thoracostomy is sometimes performed, followed by open drainage. Sometimes the doctor decides to remove some parts of the pleura with further decortication of the affected lung. If there are fistulas between the tissues of the pleura, bronchi, lungs and skin, then the surgeon closes them. In the event that the pathological process has not spread to the lungs, the doctor can decide on a partial or complete resection of the affected organ.
Traditional medicine
Therapy for such a disease must necessarily be comprehensive. And sometimes the use of various herbal remedies is allowed.
- An ordinary onion is considered effective. Preparing the medicine is easy. Peel the medium-sized onion from the husks, rinse and chop. Next, squeeze the juice and mix it with natural honey (in equal quantities). The medicine is recommended to be taken twice a day for a tablespoon. It is believed that the tool copes with cough excellent, facilitates the discharge of sputum.
- At home, you can prepare an effective mucolytic collection. It is necessary to mix equal amounts of elecampane rhizomes, coltsfoot herbs, mint, linden flowers and licorice root. 20 g of the plant mixture should be poured with a glass of boiling water, then let it brew. After cooling, filter and divide into three equal servings - they need to be drunk during the day. Every day you need to cook fresh medicine.
- Field horsetail is also considered effective. 20 g of dry grass of the plant (shredded) need to pour 0.5 liters of boiling water. The container must be covered and left for four hours in a warm place, after which the infusion is filtered. It is recommended to take 100 ml four times a day for 10-12 days.
- There is a drug collection that facilitates the breathing process and helps to cope with shortness of breath. It is necessary to remove in equal amounts the grass of the immortelle, the dried flowers of calendula with leaves of currant, tansy and bird cherry. A tablespoon of the mixture is poured with a glass of boiling water and insisted. You need to take three times a day for 2-3 tablespoons.
- There are problems with the work of the respiratory system, you need to mix equal amounts of natural honey and fresh radish juice. Herbalists recommend taking the medicine on a spoon (tablespoon) three times a day.
Of course, you can use home remedies only with the permission of a specialist.
Pleural empyema: clinical recommendations for preventing the development of an ailment
Unfortunately, specific prophylactic agents do not exist. Nevertheless, doctors advise to adhere to some rules:
- all inflammatory diseases (especially when they are accompanied by a purulent process) require timely treatment;
- it is important to strengthen the immune system, as this reduces the risk of developing such diseases (you need to try correctly, stab the body, take vitamins, spend time in the fresh air);
- do not avoid preventive examinations - the sooner the disease is detected, the less likely it is to develop certain complications.
It is worth noting that in most cases, such a disease responds well to therapy. Pleural empyema is not in vain considered a dangerous pathology - it should not be ignored. According to statistics, approximately 20% of patients develop certain complications. Mortality in such a disease ranges from 5 to 22%.