1. Dr. Ashraf A. Esmat A.Prof.Cardio-thoracic surgery Cairo university
EMPYEMA THORACIS
Dr. Ashraf A. Esmat
A.Prof.Cardio-thoracic surgery
Cairo university

2. Definition Accumulation of Pus in the Pleural cavity.
It comes from the greek word empyein ,which means :pus –producing (suppurates).

3. Aetiology Lung diseases: Pneumonia (the most common cause)
Lung abscess.
Subphrenic abscess.
Post traumatic.
Iatrogenic.
Post-operative.
Blood spread .

4. Organisms The most common:
Staph.aureus .(90% of causes in infants & children)
Strept.pneuomonie.
H.influenzae.

5. Pathological Stages Acute (exudative) stage:
Pleura fills with thin fluid that shows one or more of these criteria;
Ph < 7.4
Glucose <40 mg/dl
LDH> 1000 iu/dl
Protein > 2.5 gm/dl
Sp.gravity >1.018

6. Stages (cont.) Fibrinopurulent stage:
Thick,Opaque fluid with positive culture (pus) and Deposition of thin fibrin layer over the pleura.
Progressive loculation and formation of pouches in the pleura.

7. Stages (cont.) Organizing Stage: Presence of very thick pus .
Thick Inelaastic peel over both pleurae causing entrapment of the lung.

8. Clinical stages Acute stage : within the first 2 weeks of the onset.
Chronic Stage :
after 2 weeks or with the formation of the thick peel and loculations.

9. Causes of chronicity: Inadequate Tube Drainage.
Chronic pulmonary Disease( T.B. or Fungal Infection)
Immunosupressed patients.
Presence of Foreign body within the pleural space.

11. Symptoms & signs Fever Cough & Expectoration. Pleuretic chest pain.
Easy fatiguability.
Loss of weight.
Night sweating.

12. Complications Rupture into the lung; BronchoPleural fistula
Spread to the subcutaneous tissue;
Empyema Niscitanes
Septicaemia & septic shock.

13. Investigations
Chest X-ray.
C-T scan.
Ultrasonography
Thoracentesis

16. Management Control of the Infection process.
Drainage of pus form the pleura.
Obliteration of the space & complete Re-expansion of the Lung.

17. Drainage of Empyema Intercostal tube thoracostomy.
Intrapleural instillation of streptokinase .
V.A.T.S.
Rib Resection Drainage.
Eloesser Flap .

18. Tube thoracostomy Indications Technique When to remove
When to convert to open drainage

19. Intrapleural Streptokinase
Indications
Acute or fibrino purulent stage
Presence of loculations.
Incomplete drainage after tube insertion
Contraindications:
Chronic stage
Post-operative empyema
Empyema with BPF.

20. Technique Streptokinase 25000 iu in 50 cc of 0.9% saline solution.
Clamp the tube for 6 hours.
Open the clamp and connect tube to suction

21. Video Assisted Thoracoscopy
Indications
Technique
Limitations
complications

22. Rib Resection Drainage
Indication
Technique
Limitations

24. Eloesser Flap Drainage
Indication.
Technique.
Advantage.
Disadvantage.

26. Reexpansion of the lung & obliteration of the space
Decortication.
Muscle Transposition.
Thoracoplasty.

27. Decortication
Indications.
Technique.
Postoperative care.

29. Thoracoplasty
Conventional alexander .
Tailoring thoracoplasty.

31. THANK YOU
GOOD LUCK