This is a dangerous disease that is accompanied by inflammation of the pleural sheets with further accumulation of purulent masses in the pleural cavity. The disease requires immediate and comprehensive treatment, otherwise a host of complications may develop.
Brief information about the disease
Empyema of the pleura (ICD-10 has assigned the code J86 to this pathology) is a serious disease that is accompanied by inflammation of the pleura. At the same time, purulent masses begin to accumulate in the anatomical cavities (the pleural cavity in this case).
According to statistics, men are three times more likely to experience such a disease than the fair sex. In most cases, empyema is a complication of other pathologies.
Reasons for the development of the disease
Causes of pleural empyema can 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, the penetration of blood or air into the cavity, as well as a significantdecrease in immunity. Primary empyema (in medicine, the disease also appears under the name "purulent pleurisy") develops when:
- violation of the integrity of the chest due to injury or injury;
- previously undergone surgical interventions, if they led to the formation of bronchial fistulas;
- thoracoabdominal chest injuries.
Secondary purulent pleurisy develops against the background of other pathologies. The list of them is quite impressive:
- purulent processes in any organ system;
- inflammation of lung tissues;
- abscess formation in lung tissues;
- 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 intestinal tract;
- gangrene of the lungs;
- cholecystitis;
- peritonitis;
- formation of ulcers in the liver;
- sepsis;
- osteomyelitis;
- rupture of the esophagus;
- 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 for classifying such a pathology, because a variety of factors must be taken into account.
For example, depending on the characteristics and duration of the course, acute and chronic pleural empyema are distinguished. Symptoms of these forms can be different. For example, in an acute inflammatory-purulent process, signs of intoxication come to the fore, while the disease lasts less than a month. If we are talking about the chronic form of the disease, then the symptoms are more blurred, but they disturb 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 (there is a formation of fistulas between the pleura and the lungs, bronchi, skin through which exudate circulates).
The volume of formed pus is also taken into account:
- small empyema - the volume of purulent masses does not exceed 250 ml;
- medium, 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- or two-sided. Of course, all these characteristics are important for an effective treatment regimen.
Stages of disease development
Today, there are three stages in the 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 the pyogenic flora begins to actively multiply in the serous fluid.
- The second stage is fibro-serous. The 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, adhesions form between the sheets. Thick pus accumulates between the leaves.
- Third stage - fibrous. At this stage, the formation of dense adhesions that fetter the lung is observed. Since the lung tissue does not function normally, it also undergoes fibrotic processes.
Symptoms of pathology
Acute lung empyema is accompanied by very characteristic symptoms.
- The patient's body temperature is rising.
- There are other symptoms of intoxication, in particular, chills, pain and aches in the muscles, drowsiness, weakness, sweating.
- Cough is a characteristic symptom of empyema. At first it is dry, but gradually becomes productive. When coughing, sputum is greenish-yellow, gray or rye. Often, the discharge has an extremely unpleasant odor.
- The list of symptoms also includes shortness of breath - at first it appears only during physical activity, but then the patient is disturbed at rest.
- As the pathology progresses, pain in the sternum appears,which increase on exhalation and inhalation.
- Changes in the functioning of the respiratory system also affect the functioning of the heart, causing certain disturbances in its rhythm.
- Patients complain of constant weakness, fatigue, decreased performance, feeling overwhelmed, lack of appetite.
- Disorders of the respiratory system are sometimes accompanied by some external symptoms. For example, the skin on the patient's lips and fingertips becomes bluish.
According to statistics, in about 15% of cases the process becomes chronic. However, the clinical picture is different. Symptoms of intoxication are absent, as well as fever. Cough disturbs the patient constantly. Patients also complain of recurrent headaches. If left 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:
- dystrophic changes in the kidneys;
- serious damage to the myocardium, kidneys and some other organs;
- formation of blood clots, blockage of blood vessels;
- multiple organ failure;
- formation of bronchopleural fistulas;
- development of amyloidosis;
- thrombo-related pulmonary embolism (requires emergency surgery as otherwisecase, 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, but also determining the nature of the pathological process, the degree of its spread, and the causes of occurrence.
- To begin with, an anamnesis is collected, a study of the patient's medical data. With an external examination of the chest, one or another degree of deformation, bulging or smoothing of the intercostal spaces may be noticed. If we are talking about chronic pleural empyema, then the patient has scoliosis. Very characteristic is the drooping of the shoulder and the protrusion of the scapula on the side of the lesion.
- Auscultation is mandatory.
- In the future, the patient is referred for various studies. Mandatory are laboratory tests of blood and urine, during which it is possible to determine the presence of an inflammatory process. Microscopic examination of sputum and aspirated fluid is carried out.
- Exudate samples are used for bacterial culture. This procedure allows you to determine the type and type of pathogen, 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- a procedure that helps to detect fistulas (if any).
- Pleural puncture and ultrasonography of the pleural cavity will also be foreseen.
- Sometimes the patient is additionally sent for magnetic resonance and/or computed tomography. Such studies help the doctor evaluate the structure and functioning of the lungs, detect the accumulation of exudate and evaluate its volume, and diagnose the presence of certain complications.
Based on the data received, 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 is to some extent associated with the activity of pathogenic microorganisms, antibiotics with a wide spectrum of effects in the form of tablets must be introduced into the treatment regimen. Drugs from the group of aminoglycosides, cephalosporins, fluoroquinolones are considered effective. In addition, sometimes antibacterial agents are injected directly into the pleural cavity for maximum results.
Sometimes patients are prescribed transfusions of protein preparations, for example, special hydrolysates, albumin, purified blood plasma. Additionally, solutions of glucose and electrolytes are introduced, which help restore the body.
Immunomodulatory therapy is mandatory, as well as taking vitamin complexes - this helps to 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, antipyretics and non-steroidal anti-inflammatory drugs are used.
After the symptoms of empyema become less pronounced, physical therapy is recommended for patients. Special breathing exercises help strengthen the intercostal muscles, normalize lung function, and saturate the body with oxygen. A therapeutic massage will also be useful, which also helps to clear the lungs of sputum, improve the well-being of the body. Additionally, sessions of therapeutic gymnastics are held. Ultrasound therapy also gives good results. During rehabilitation, doctors recommend patients to undergo restorative spa treatment.
When is surgery needed?
Unfortunately, sometimes only surgery helps to cope with the disease. Pleural empyema, which is characterized by a chronic course and accumulation of a large amount of pus, requires surgical intervention. Such methods of therapy allow you to remove the symptoms of intoxication, eliminate fistulas and cavities, straighten the affected lung, remove purulent exudate and sanitize the pleural cavity.
Sometimes a thoracostomy followed by open drainage is performed. Sometimes the doctor decides to remove some sections of the pleura with furtherdecortication 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 may decide on a partial or complete resection of the affected organ.
Traditional medicine
Therapy for such a disease must be comprehensive. And sometimes the use of various herbal remedies is allowed.
- An ordinary bow is considered effective. Preparing the medicine is easy. Peel a medium-sized onion from the husk, rinse and chop. Next, you need to squeeze the juice and mix it with natural honey (in equal amounts). The medicine is recommended to be taken twice a day for a tablespoon. It is believed that the tool is excellent at coping with coughs, facilitates sputum discharge.
- At home, you can prepare an effective mucolytic collection. You need 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. The remedy after cooling by filtering and divided into three equal portions - they need to be drunk during the day. Fresh medicine should be prepared every day.
- Horsetail is also considered effective. 20 g of dry grass of the plant (crushed) should be poured with 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 10-12days.
- There is a medicinal collection that facilitates the process of breathing and helps to cope with shortness of breath. It is necessary to displace equal amounts of immortelle grass, dried calendula flowers with currant leaves, tansy and bird cherry. A tablespoon of the mixture is poured with a glass of boiling water and insisted. You need to take 2-3 tablespoons three times a day.
- If there are problems with the functioning of the respiratory system, then you need to mix equal amounts of natural honey and fresh radish juice. Herbalists recommend taking medicine in a spoon (table) three times a day.
Of course, you can use home remedies only with the permission of a specialist.
Empyema of the pleura: clinical guidelines for preventing the development of the disease
Unfortunately, there are no specific preventive measures. Nevertheless, doctors advise to adhere to some rules:
- all inflammatory diseases (especially when they are accompanied by a purulent process) require timely therapy;
- 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 earlier 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, approximately20% of patients develop certain complications. Mortality in this disease ranges from 5 to 22%.
