Pus in the thorax: management of empyema and lung abscess

Walters, James; Foley, Noeleen; Molyneux, M.

doi:10.1093/bjaceaccp/mkr036

Cited by 12 publications

(19 citation statements)

References 13 publications

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“…The major aetiologic agents of lung abscesses are anaerobes and microaerophilic streptococci, which are part of the normal flora colonising the oral cavity and gingival crevices 3 8–11. Anaerobic bacteria are difficult to isolate from respiratory specimens, but various studies showed that anaerobic infections can be diagnosed based on the presence of a characteristic foul-smelling putrid discharge in patients with a lung abscess,9 as it was the case in our patient.…”

Section: Discussionmentioning

confidence: 55%

“…Lung abscesses are more frequently observed in male patients over the age of 50 with altered state of consciousness, such as alcoholics or epileptics, since the majority arise from aspiration of oral cavity secretions, being typically localised in posterior segments of the lungs 1 3 7–9. Dental and periodontal infection, as displayed by our patient, also increases the risk for aspirating oropharyngeal bacteria, as well as dysphagia or gastro-oesophageal reflux disease.…”

Section: Discussionmentioning

confidence: 66%

“…Dental and periodontal infection, as displayed by our patient, also increases the risk for aspirating oropharyngeal bacteria, as well as dysphagia or gastro-oesophageal reflux disease. Other predisposing factors include bronchial obstruction, coexisting lung diseases, pneumonia, diabetes mellitus, immunosuppression and extra-pulmonary infections with haematogenous spread or direct extension from contiguous structures 3 6–8…”

Section: Discussionmentioning

confidence: 99%

“…Medical treatment with antibiotics and respiratory physiotherapy to aid drainage is the mainstay of therapy for lung abscesses, being successful in the majority of cases (80%–90%) 3 6–8 17 18. A 4–6 weeks antibiotic course is consensual in the literature,2 3 8 but it may be prolonged depending on patient’s clinical and radiological evolution, as well as isolated pathogens. Empirical treatment should cover aerobic and anaerobic bacteria.…”

Section: Discussionmentioning

confidence: 99%

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Unusual case of a giant lung abscess initially misdiagnosed and treated as an empyema

Carvalho¹,

Marques

Oliveira

et al. 2019

BMJ Case Rep

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We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. A follow-up chest CT performed to rule out bronchopleural fistula revealed a large lung abscess. The patient had the final diagnosis of a giant lung abscess, which was initially thought to be an empyema because of the clinical and radiologic similarities with this entity. The initial misdiagnosis led to prompt percutaneous drainage of the lung abscess in addition to antibiotherapy and respiratory physiotherapy with a good final outcome, which suggests the efficacy of this approach in similar cases.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Unusual case of a giant lung abscess initially misdiagnosed and treated as an empyema

Carvalho¹,

Marques

Oliveira

et al. 2019

BMJ Case Rep

View full text Add to dashboard Cite

show abstract

“…The key aspects of empyema thoracis treatment are fluid drainage, antibiotics and nutrition. 13 Moreover, the timing of empymectomy is also very important. Those who were treated in less than 4 weeks of duration gives better outcome than one treated more than 4 weeks duration.…”

Section: Discussionmentioning

confidence: 99%

Concomitant primary peritonitis, septic shock and empyema thoracis in a young girl: a rare case report

Singh

Jeyasekharan

et al. 2019

Int Surg J

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Primary peritonitis is a condition in which there is no intraabdominal source of infection demonstrated during laparotomy. It is uncommon and can affect any age group from childhood to the elderly. We report here a case of Primary peritonitis with septic shock as a presenting feature, associated with empyema thoracis. This combination was not reported previously in the literature. Our patient was a 15-yr old girl with a ten day history of fever, cough, dyspnea, abdominal pain and loose stools initially treated elsewhere. She was brought to the emergency in a gasping state, bradycardia, hypotension, tachypnoea and a distended abdomen. She was intubated, resuscitated and a bedside ultrasound revealed free fluid present all over peritoneal cavity. Emergency laparotomy under general anesthesia showed extensive thick yellow coloured nonfoul-smelling purulent fluid all over the peritoneal spaces with distended bowel loops. A thorough search confirmed no evidence of hollow-viscus perforation, peritoneal lavage, appendicectomy and laparostomy were done. Postoperatively she was ventilated electively and managed in a high dependency care unit with broad spectrum antibiotics and respiratory supportive measures. However she continued to have high fever, tachycardia, tachypneic and developed left massive pyothorax. Thoracoscopic drainage of the flakes of pus in the pleural cavity with extensive decortication done. Then, once her sepsis was well controlled, underwent laparostomy closure. However, post laparostomy-closure had signs of LV dysfunction with respiratory failure and managed with cardiac drugs. She had a turbulent postoperative course, gradually recovered, and was discharged home after nine weeks of admission.

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Multidisciplinary reconstructive management of residual recalcitrant empyema cavity: A retrospective observational cohort study

Allen¹,

Milton²,

Bourke³

2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Pus in the thorax: management of empyema and lung abscess

Cited by 12 publications

References 13 publications

Unusual case of a giant lung abscess initially misdiagnosed and treated as an empyema

Unusual case of a giant lung abscess initially misdiagnosed and treated as an empyema

Concomitant primary peritonitis, septic shock and empyema thoracis in a young girl: a rare case report

Multidisciplinary reconstructive management of residual recalcitrant empyema cavity: A retrospective observational cohort study

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