Differentiating lung abscess and empyema: radiography and computed tomography

Stark, David D.; Federle, MP; Goodman, Philip C.; Podrasky, Ann E.; Webb, W. Richard

doi:10.2214/ajr.141.1.163

Cited by 271 publications

(116 citation statements)

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“…The analyses were performed using the program Statistical Package for the Social Sciences, the pleural space; and septations seen on ultrasound or CT scans. (14,15) In the children who presented complicated parapneumonic pleural effusion with septations, thoracoscopy was performed as an initial procedure. Some of the children had previously undergone closed chest tube drainage, and, due to persistent fever and radiological findings of pleural septations, subsequently underwent thoracoscopy.…”

Section: Introductionmentioning

confidence: 99%

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

2009

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Objective: To determine the efficacy of thoracoscopy in the management of children with complicated parapneumonic pleural effusion at the fibrinopurulent stage. Methods: Retrospective study of 99 children submitted to thoracoscopy for the treatment of complicated parapneumonic pleural effusion at the fibrinopurulent stage between November of 1995 and July of 2005. The mean age was 2.6 years (range, 0.4-12 years), and 60% were males. Thoracoscopy was performed at three different hospitals following the same treatment algorithm. Results: Thoracoscopy was effective for 87 children (88%). In 12 (12%), a second surgical procedure was required: another thoracoscopy (n = 6) or thoracotomy/thoracostomy (n = 6). Mean duration of chest tube drainage following successful thoracoscopy was 3 days vs. 10 days in patients submitted to a second procedure (p < 0.001). In all of the children, the pleural infection resolved after treatment. Thoracoscopy-related complications included air leak (30%), chest tube bleeding (12%), subcutaneous emphysema associated with trocar insertion (2%) and surgical wound infection (2%). None of the children required additional surgical procedures due to the complications. Conclusions:The effectiveness of thoracoscopy in children with parapneumonic pleural effusion at the fibrinopurulent stage was 88%. The procedure was safe, with a low rate of severe complications. Thoracoscopy should be the first-choice treatment for children with parapneumonic pleural effusion at the fibrinopurulent stage.Keywords: Thoracoscopy; Pleural effusion; Empyema, pleural. ResumoObjetivo: Determinar a eficácia da toracoscopia em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta entre novembro de 1995 e julho de 2005. A média de idade foi de 2,6 anos (variação, 0,4-12 anos) e 60% eram do sexo masculino. A toracoscopia foi realizada em três hospitais diferentes utilizando-se o mesmo algoritmo de tratamento. Resultados: A toracoscopia foi eficaz em 87 crianças (88%) e 12 (12%) necessitaram de outro procedimento cirúrgico: nova toracoscopia (n = 6) ou toracotomia/pleurostomia (n = 6). O tempo médio de drenagem torácica foi de 3 dias nas crianças em que a toracoscopia foi efetiva e de 10 dias naquelas que precisaram de outro procedimento (p < 0,001). A infecção pleural de todas as crianças foi debelada após o tratamento. As complicações da toracoscopia foram fuga aérea (30%) e sangramento pelo dreno torácico (12%), enfisema subcutâneo na inserção do trocarte (2%) e infecção da ferida operatória (2%). Nenhuma criança necessitou de reoperação devido às complicações. Conclusões: A efetividade da toracoscopia em crianças com DPPC na fase fibrinopurulenta foi de 88%. O procedimento mostrou-se seguro, com baixa taxa de complicações graves, devendo ser considerado como primeira opção em crianças com DPPC na fase fibrinopurulenta. Original ArticleThoracoscopy in childre...

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Section: Introductionmentioning

confidence: 99%

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

2009

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“…10 In general abscesses are round in shape, and appear similar in both frontal and lateral projections. The abscesses can be single or multiple.…”

Section: Discussionmentioning

confidence: 99%

Two cups of Tuberculosis in Chest

2017

Int. J. Curr. Res. Med. Sci.

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“…Mediastinal pathologies can be classified as masses, infections and vascular [11,12]. Parenchymal pathologies can be categorized as infections, abscess, empyema, pleural effusion and peripheral lung tumors [1,13]. Presence of fat density in the CT examination restricts the differential diagnosis to diaphragmatic hernia, mediastinal lipomatosis [14], pericardial fat necrosis, lipoma, liposarcoma or fat pad [1].…”

Section: Discussionmentioning

confidence: 99%

Diaphragmatic Hernias: A Cause of Unilateral Loss of The Cardiophrenic Sinus Angle

Zan¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Kardiyofrenik boşluk mediastenin en bazal kısmı olup kalp, diyafragma ve göğüs duvarı ile çevrilidir. Kardiyofrenik boşluk yağ dokusu ile dolu olup keskin sınırlıdır. Ancak enfeksiyonlar, inflamasyon ve diyafragmatik herniler gibi bazı yer kaplayan lezyonlar kardiyofrenik sinuste küntleşmeye neden olabilir. Biz bu çalışma ile kardiyofrenik sinuste küntleşmeye neden olan diyafragmatik hernilerin insidansını bulmayı amaçladık. Gereç ve Yöntem: 983 çok kesitli toraks bilgisayarlı tomografisi tek taraflı kardiyofrenik yağlı doku artı-şı açısından kliniğimizde araştırılmıştır. Tek taraflı (sağ/sol) küntleşmesi olan 200 olgu çalışmaya dahil edilmiştir. Tüm olgularda dansite ölçümü yapıla-rak kardiyofrenik sinuste yağ dokusu varlığı teyit edilmiştir. Yapılan istatistiksel analiz ile yaş, cinsiyet, sağ ve sol taraflı atelektazi ve eşlik eden diyafragmatik herni varlığı açısından anlamlı farklılık olup olmadığı araştırılmış-tır. Bulgular: Çalışmaya dahil edilen olguların 107'si kadın (%53.5), 93'ü erkek (%46.5) olarak saptandı. Olguların %28'inde diyafragmatik herni saptandı. Diyafragmatik hernisi olan olguların %31'i bayan, %24'ü erkek olarak saptanmış olup Morgagni herni insidansı %14.5 dir. Bayanlarda erkeklere göre daha sık saptanmış olup istatistiksel olarak anlamlı bulunmuştur (p<0.05). Tüm olgularda en sık sağda (%89) izlenmiştir. Sonuç: Diyafragmatik defektler sıklıkla asemptomatik olup ileri yaş hasta grubunda daha sık saptanmaktadır. Tek taraflı kardiyofrenik sinuste küntleşmesi olan olgularda diyafragmatik herniler ayırıcı tanıda düşünülmelidir. Diyafragmatik herni komşuluğun-daki akciğer dokusunda atelektazi çok sık izlenmektedir. Ancak atelektazinin çok çeşitli nedenleri olmasından dolayı diyafragmatik herni tanısındaki yön-lendirici değeri düşüktür. Anahtar KelimelerÇok Kesitli Bilgisayarlı Tomografi; Kardiyofrenik Sinus; Morgagni Hernisi Abstract Aim: Cardiophrenic space is the most basal portion of the mediastinum and surrounded by heart, diaphragm and chest wall. Cardiophrenic space full with fatty tissue shows a sharp angles. However, some space-occupying lesions, infections, inflammations and diaphragmatic herniation can be the cause of the blunt cardiophrenic sinus angle. The aim of this study is to determine the incidence of loss of the cardiophrenic sinus angle due to diaphragmatic hernias. Material and Method: We retrospectively evaluated 983 consecutive chest multidetector computed tomography images for presence of unilaterally increased fat tissue. 200 patients who had blunting in the cardiophrenic (right or left) sinus were included in the study. Density measurements proved the presence of adipose tissue in the cardiophrenic sinus in all patients. The relationship between age, gender and right or left sided atelectasis and associated diaphragmatic hernias were statistically analyzed. Results: 107 patients were female (53.5%) and 93 (46.5%) were male. 28% of patients had diaphragmatic hernia. 31% of females and 24% of males had diaphragmatic hernia. Incidence of the Morgagni hernia was ...

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Differentiating lung abscess and empyema: radiography and computed tomography

Cited by 271 publications

References 3 publications

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

Toracoscopia em crianças com derrame pleural parapneumônico complicado na fase fibrinopurulenta: estudo multi-institucional

Two cups of Tuberculosis in Chest

Diaphragmatic Hernias: A Cause of Unilateral Loss of The Cardiophrenic Sinus Angle

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