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Complications Diagnosis And Treatment Of Empyema

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Empyema is a medical term commonly called for the condition in which pus (the fluid that is filled with immune cells, dead cells, and bacteria) and fluid from infected tissues collect in a body cavity. If it is left untreated, it can form a bacterial infection. Most commonly, the pus is developed in the pleural space. It is the slim space between the outside of the lungs and the inside of the chest cavity. This medical condition is also referred to as pyothorax or purulent pleuritis. 

  • Pneumonia: Generally, empyema is developed after pneumonia caused by a bacterial infection of the lungs. The main two bacterias that cause pneumonia are Streptococcus pneumonia and Staphylococcus pneumonia. It may happen after you had surgery on your chest. 

  • Bronchiectasis: It is a lung condition that causes coughing up mucus due to the scarred tissues in the bronchi. In people having this condition, the inner surfaces of the bronchi get thicker over time from inflammation that leaves scars. These thicker walls collect mucus in the passages. Empyema is the most common complication due to Empyema.

  • Blood clot or blockage: This will prevent blood flow to your lungs and some of the lung cells will die due to this. The medical term for this condition is pulmonary infarction and causes empyema rarely.

  • Diabetes: It is a metabolic disease that causes high blood sugar. The hormone insulin moves glucose from the blood into your cells to be stored or used for energy. 

Complications Of Empyema

What are the Symptoms of Empyema?

The most common symptoms of empyema are:

  • Fever
  • Night Sweats
  • Energy Loss
  • Breathing Difficulties
  • Loss Of Weight
  • Chest Pain
  • Dry Cough
  • Chills
  • Discomfort and uneasiness
  • Ill Feeling
  • Headache
  • Loss Of Appetite

What are the Complications of Empyema?

  • Fibrosis
  • Empyema Necessitatis
  • Sepsis
  • Pneumothorax

Fibrosis


Fibrosis is a condition in which fibrous connective tissue will develop as a reparative response to an injury or damage. This may due to the deposition of connective tissue as a part of the normal healing or to the excess tissue deposition that occurs as a pathological process. One of the causes of this may be empyema. Different types of fibrosis are:

1

   Pulmonary Fibrosis

This condition causes intestinal lung damage, followed by fibrosis, and eventually losses lung elasticity. The symptoms of pulmonary fibrosis are persistent cough, chest pain, breathing difficulties, and fatigue. Basically, pulmonary fibrosis is a lung disease that occurs when lung tissue becomes damaged and scarred. This makes it more difficult for your lungs to work properly. Pulmonary fibrosis is of three types. They are:

Replacement Fibrosis

Focal Fibrosis

Diffuse Parenchymal Lung Disease(DPLD)

The condition of pulmonary fibrosis develop later in life and the preventive measures are:

  • Stop smoking
  • Avoid Exposure to irritating dust or substances
  • Avoid drugs that contain immunosuppressive agents or antifibrotic agents

2

Liver Cirrhosis

It is the late stage of fibrosis in the liver caused by many forms of liver diseases and conditions. It is a complication of liver disease that involves loss of liver cells and irreversible scarring of the liver. It may cause weakness, loss of appetite, easy bruising, itching, and fatigue. Its complications include:

  • Swelling of the abdomen
  • Bacterial Peritonitid
  • Bleeding
  • Hepatic Encephalopathy
  • Hepatorenal Syndrome
  • Hepatopulmanory Syndrome
  • Liver Cancer

3

Cardiac Fibrosis  

Cardiac fibrosis is characterized by an increased collagen type1 deposition as well as cardiac fibroblast activation and differentiation into myofibroblasts. The main cause of cardiac fibrosis is the increased accumulation of extracellular matrix that impacts cardiac function. There are four types of cardiac fibrosis. They are:

  • Reactive interstitial fibrosis
  • Replacement Fibrosis
  • Infiltrative Interstitial Fibrosis
  • Endomyocardial Fibrosis

This type of fibrosis occurs when healthy cardiac cells are replaced with fibrous connective tissue, causing scarring and less compliant cardiac muscles.

Empyema Necessitatis


It is a rare complication of empyema and the most common cause of empyema necessitatis is a mycobacterial infection, streptococcus, and staphylococcus infection. Empyema necessitatis is a rare clinical entity in which an infection that produces a large number of pus forms in the soft tissues due to a sinus tract between an empyema and the thoracic wall. It should be suspected in any patient with pulmonary symptoms presenting with a chest wall mass as well as in patients with skin infections on the chest wall. 

Sepsis 


Sepsis is caused by your body’s response to an infection. As a response to an infection, your immune system releases a chemical into the bloodstream. These chemicals develop the condition known as sepsis. Symptoms of sepsis are:

  • Intense temperature and fever
  • High Heart Rate
  • Higher breathing rate
  • Infection

Symptoms of severe sepsis are:

  • Discolored skin
  • Urination decreases
  • Platelet count decreases
  • Breathing difficulties
  • Fatigue
  • Abnormal Heart Functioning
  • Weakness

Symptoms of septic shock include low blood pressure and severe sepsis. Severe cases of sepsis may lead to septic shock and it is a medical emergency.

Pneumothorax 

 


Pneumothorax is the presence of air or gas in the cavity between the lungs and the chest wall causing the collapse of lungs. Pneumothorax is mainly caused by empyema, penetrating chest injury, or damage from lung disease. The symptoms of pneumothorax include sudden chest pain and breathing difficulties. The two types of pneumothorax are primary spontaneous pneumothorax and secondary spontaneous pneumothorax. Primary spontaneous pneumothorax is a no predisposing lung disease and secondary spontaneous pneumothorax is due to the underlying lung abnormality.

Diagnosis And Treatment Of Empyema

If a patient with pneumonia is not responding to treatments and medicines, then you must start diagnosis and treatment of empyema. Doctors can hear abnormal sounds from the patients’ lungs by using their stethoscope. The tests for diagnosing empyema are:

  • Chest X-rays to know whether or not there is fluid in the pleural space

  • CT scans and ultrasound of the chest will show the amount of the fluid and its location

  • Blood tests to check the count of white blood cells and to identify the bacteria causing the infection

  • Thoracentesis, a needle is inserted through the back of the patients’ ribcage to take the sample of the fluid in the pleural space.

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    Treatment of empyema involves removing the pus and fluid from the pleural space and antibiotics are used to treat the infection. The type of antibiotic depends on the bacteria that is infected. The method used to treat empyema also depends on the stage of the empyema.  

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