Parapneumonic Effusions and Empyema

Abstract

Parapneumonic effusions occur in 20 to 40% of patients who are hospitalized with pneumonia. The mortality rate in patients with a parapneumonic effusion is higher than that in patients with pneumonia without a parapneumonic effusion. Some of the excess mortality is due to mismanagement of the parapneumonic effusion. Characteristics of patients that indicate that an invasive procedure will be necessary for its resolution include the following: an effusion occupying more than 50% of the hemithorax or one that is loculated; a positive Gram stain or culture of the pleural fluid; and a purulent pleural fluid that has a pH below 7.20 or a glucose below 60, or has a lactic acid dehydrogenase level of more than three times the upper normal limit for serum. Patients with pneumonia and an effusion of more than minimal size should have a therapeutic thoracentesis. If the fluid cannot be removed with a therapeutic thoracentesis, a chest tube should be inserted and consideration be given to the intrapleural instillation of fibrinolytics. If the loculated effusion persists, the patient should be subjected to video-assisted thoracoscopic surgery, and if the lung cannot be expanded with this procedure, a full thoracotomy with decortication should be performed. The definitive procedure should be performed within 14 d.

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

“…Empyema was defined as pleural effusion with thick, purulent-appearing pleural fluid (14) or in which bacterial or fungal cultures are positive (15). We reviewed cases of culture-positive empyema occurring in our hospital from 1995 to 2009 and followed this with retrospective analysis of the subset of these cases in which gastrointestinal tract perforation resulted in empyema.…”

Outcomes of patients with chest tube insertion for hepatic hydrothorax

“…Empyema was defined as pleural fluid with grossly purulent appearance, positive culture result, or pH below 7.20 [15]. The diagnosis of cellulitis at the chest tube site was based on clinical assessment.…”

Optimising the utility of pleural fluid adenosine deaminase for the diagnosis of adult tuberculous pleural effusion in Hong Kong

“…28 The PF is often exudative with a predominance of neutrophils. 28 It can be 'simple' (with sterile exudate) or 'complicated' (with progression to a fibrinopurulent state), characterised by pH <7.2, glucose level of <2.2 mmol/L, and LDH level of >1000 IU/L. 29 Empyema thoracis is a complicated parapneumonic effusion with frank pus.…”

“…29 Empyema thoracis is a complicated parapneumonic effusion with frank pus. 28 A definitive diagnosis of simple non-tuberculous parapneumonic effusion was made if the PF was exudative and sterile with LDH level of ≤1000 IU/L and if there was a compatible clinical response to empirical antibiotic treatment, in the absence of an alternative diagnosis by 1 year after the first attempt of diagnostic thoracentesis. Without an identifiable non-tuberculous pathogen, we considered it impossible to confidently make an early diagnosis of simple non-tuberculous parapneumonic effusion.…”