Lung abscess or empyema? Taking a closer look

Hassan, Maged; Asciak, Rachelle; Rizk, R. A. M.; Shaarawy, Hany; Gleeson, Fergus; Rahman, Najib M.

doi:10.1136/thoraxjnl-2018-211604

Cited by 13 publications

(7 citation statements)

References 7 publications

(7 reference statements)

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“…Homogeneously echogenic effusions tend to occur with haemorrhagic pleural effusions and empyema [11]. A less known sonographic sign, the "suspended microbubble sign", which describes echogenic shadows floating up the ultrasound screen and represents gas bubbles is occasionally depicted in purulent pleural collections [12,13]. Pleural aspiration is required to determine the nature of any effusion and, should infection be diagnosed, a small-bore chest tube will be required.…”

Section: Diagnosis Infectionmentioning

confidence: 99%

Thoracic ultrasound in the modern management of pleural disease

2020

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Physician-led thoracic ultrasound (TUS) has substantially changed how respiratory disorders, and in particular pleural diseases, are managed. The use of TUS as a point-of-care test enables the respiratory physician to quickly and accurately diagnose pleural pathology and ensure safe access to the pleural space during thoracentesis or chest drain insertion. Competence in performing TUS is now an obligatory part of respiratory speciality training programmes in different parts of the world. Pleural physicians with higher levels of competence routinely use TUS during the planning and execution of more sophisticated diagnostic and therapeutic interventions, such as core needle pleural biopsies, image-guided drain insertion and medical thoracoscopy. Current research is gauging the potential of TUS in predicting the outcome of different pleural interventions and how it can aid in tailoring the optimum treatment according to different TUS-based parameters.

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Section: Diagnosis Infectionmentioning

confidence: 99%

Thoracic ultrasound in the modern management of pleural disease

2020

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“…Nonresolution of infection warrants surgical referral for decortications and/or open drainage. 3,4,13,14,15 Our patient had a RAPID score of 3 with a predicted possible mortality of 17.5 per cent at three months. He was fully ambulant and self-caring.…”

Section: Discussionmentioning

confidence: 70%

Ambulatory drainage and management of a pleural empyema

Aujayeb¹,

Jackson²,

Johnston³

2020

Acute Med J

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A 61 year old male presented to chest clinic with a lung abscess. This ruptured and resulted in an empyema that required a small bore chest drain. Pus started bypassing the drain, spilling out subcutaneously. This was probably due to the impending formation of an empyema necessitans. To stem the flow, a large bore drain was inserted. An ambulatory bag was connected to the end of that drain which enabled outpatient management through the ambulatory care unit over a ten week period. The chest drain stayed in for nine weeks. Risk stratification using the RAPID score was applied. This is a routine medical presentation with well-known and accepted investigations with routine organisms (mixed aerobic and anaerobic microbiota) and treatment with classical broad spectrum antibiotics. The striking feature of the case is that with strict supervision, patient education and motivation, ambulatory management is perfectly feasible and safe.

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“…6 While a chest X-ray can be helpful, the sensitivity and specificity of these findings for differentiating a pulmonary abscess from an empyema are lacking and can result in an incorrect diagnosis. 7 Thoracic CT, on the contrary, is a highly effective diagnostic tool and the preferred modality to differentiate these 2 lung pathologies. One study by Stark et al 8 revealed that CT alone was sufficient to correctly diagnose 100% (70/70) of inflammatory thoracic lesions as either lung abscesses or empyemas.…”

Section: Discussionmentioning

confidence: 99%

“…On chest X-rays, empyemas may have the classic lenticular shape and obtuse angle formation with the adjacent wall, but this pattern alone should not guide clinical judgment and a thoracic CT should be the next diagnostic tool to distinguish these 2 clinical conditions. 7 Key initial characteristic features to look for are the thinner walls and smoother lumen of an empyema. 8 In addition, empyemas are known to compress lung parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Empyema Versus Lung Abscess: A Case Report

Imburgio

Tavakolian

Mararenko

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Lung abscesses and empyemas are 2 forms of pulmonary infection that can present with similar clinical features. However, empyemas are associated with higher morbidity and mortality, necessitating the need to distinguish one from the other. Plain radiographs can sometimes provide clues to help differentiate the 2 pathologies but more often than not, a computed tomography scan is required to confirm the diagnosis. Correct diagnosis is essential, as the goal standard therapeutic intervention for empyemas may be contraindicated in patients with lung abscesses. Empyemas require percutaneous or surgical drainage in combination with antibiotics, while lung abscesses are generally treated with antibiotics alone as drainage can be associated with various complications. We present a case of a 65-year-old man with parapneumonic empyema diagnosed with characteristic findings on chest computed tomography and treated with surgical drainage and antibiotics. We hope to improve patient outcomes by highlighting the classical radiographic findings that help distinguish empyema and abscess.

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Lung abscess or empyema? Taking a closer look

Cited by 13 publications

References 7 publications

Thoracic ultrasound in the modern management of pleural disease

Thoracic ultrasound in the modern management of pleural disease

Ambulatory drainage and management of a pleural empyema

Empyema Versus Lung Abscess: A Case Report

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