Materiały źródłowe

• #1 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  Defined as a collection of pus in the thoracic cavity arising from infection in the pleural space, empyema is most commonly caused by bacterial pneumonia and the resulting accumulation of fluid (parapneumonic effusion) in the pleural space. […] Prompt diagnosis and drainage of pleural space infection are critical in the treatment and management of empyema. […] The diagnosis of empyema is confirmed by the presence of pus, positive Gram stain, or culture in the pleural fluid. […] AATS recommends pleural fluid analysis for all patients showing symptoms of pneumonia or unexplained sepsis as well as for patients whose pneumonia does not respond to antibiotic therapy. […] To identify a pleural space infection, AATS recommends the use of chest radiography. […] If pleural space infection is suspected, computed tomography (CT) of the chest is recommended.

• #2 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Thoracic empyema, characterized by the presence of purulent fluid in the pleural space, remains a significant clinical challenge with considerable morbidity and mortality. […] Early diagnosis and aggressive management, including antimicrobial therapy, drainage procedures, and sometimes surgery, are critical for favorable outcomes. Diagnostic strategies hinge on imaging and pleural fluid analysis, while treatment aims to eradicate infection, facilitate lung reexpansion, and prevent long-term complications. […] Recognizing the early signs of pleural space infections, differentiating empyema from other pleural conditions, and employing advanced diagnostic and therapeutic techniques facilitate improved outcomes. […] Prompt diagnosis and intervention are crucial for improving patient outcomes, as treatment hinges on integrating medical and surgical strategies to eradicate the infection and facilitate lung reexpansion.

• #3 Empyema – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1008

  Empyema is defined as the presence of pus in the pleural space. […] In patients with symptoms and signs of infection and a significant pleural effusion, thoracentesis (pleural aspiration) must be performed urgently. […] If empyema or a complicated parapneumonic effusion is diagnosed, a chest drain must be inserted urgently. […] Diagnostic investigations include blood cultures, CRP, WBC count, metabolic panel, chest x-ray, thoracic ultrasound, and thoracentesis for pleural fluid analysis. […] Key diagnostic factors include the presence of risk factors, recent pneumonia, constitutional symptoms, pyrexia and rigors, dullness to percussion, reduced breath sounds, and signs of sepsis. […] Other diagnostic factors include subacute presentation, productive cough, pleuritic chest pain, dyspnoea, and recent instrumentation of the pleural space.

• #4 Empyema – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1008

  Empyema is defined as the presence of pus in the pleural space. […] In patients with symptoms and signs of infection and a significant pleural effusion, thoracentesis (pleural aspiration) must be performed urgently. […] If empyema or a complicated parapneumonic effusion is diagnosed, a chest drain must be inserted urgently. […] A prolonged course of antibiotics is also required. […] If patients do not improve with antibiotics and drainage of the pleural space, surgery or intrapleural enzyme therapy should be considered. […] Key diagnostic factors include presence of risk factors, recent pneumonia, constitutional symptoms, pyrexia and rigors, dullness to percussion, reduced breath sounds and reduced vocal resonance, and signs of sepsis. […] Other diagnostic factors include subacute presentation, productive cough, pleuritic chest pain, dyspnoea, and recent instrumentation of the pleural space.

• #5 Diagnosis and management of pleural infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10790177/

  Pleural infection remains a medical challenge. Diagnosis presents challenges due to non-specific clinical presenting features. Imaging techniques such as chest radiographs, thoracic ultrasound and computed tomography scans aid diagnosis. Pleural fluid analysis, the gold standard, involves assessing gross appearance, biochemical markers and microbiology. Novel biomarkers such as suPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor-1) show promise in diagnosis and prognosis, and microbiology demonstrates complex microbial diversity and is associated with outcomes. […] Clinical presentation of pleural infection is non-specific and variable; therefore, early diagnosis can be challenging. Several risk factors, such as immunosuppression, diabetes, poor oral hygiene, gastro-oesophageal reflux, alcohol excess and intravenous drug use, are known to independently predict increased risk of progression of pneumonia to pleural infection. However, there are currently no validated clinical risk prediction tools that predict the development of pleural infection from pneumonia. A reliable prediction tool for parapneumonic effusion and pleural infection in patients with pneumonia would allow identification of patients that are at high risk of developing these conditions, thereby allowing close monitoring of this group and, therefore, early detection and management to improve outcomes.

• #6 Empyema – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1008

  Empyema is defined as the presence of pus in the pleural space. […] In patients with symptoms and signs of infection and a significant pleural effusion, thoracentesis (pleural aspiration) must be performed urgently. […] If empyema or a complicated parapneumonic effusion is diagnosed, a chest drain must be inserted urgently. […] A prolonged course of antibiotics is also required. […] If patients do not improve with antibiotics and drainage of the pleural space, surgery or intrapleural enzyme therapy should be considered. […] Key diagnostic factors include presence of risk factors, recent pneumonia, constitutional symptoms, pyrexia and rigors, dullness to percussion, reduced breath sounds and reduced vocal resonance, and signs of sepsis. […] Other diagnostic factors include subacute presentation, productive cough, pleuritic chest pain, dyspnoea, and recent instrumentation of the pleural space.

• #7 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Chest imaging is a cornerstone of empyema diagnosis and management as it provides critical information about pleural infections’ presence, extent, and nature. […] Diagnostic fluid sampling via thoracentesis is essential in evaluating pleural effusions associated with pneumonia, recent chest trauma, surgery, or ongoing sepsis, particularly when effusion depth exceeds 2 cm on lateral decubitus films or CT. […] Pleural fluid analysis begins with assessing appearance, as grossly purulent fluid strongly suggests empyema. Biochemical markers are also crucial, with empyema typically characterized by low pH (7.2), low glucose (60 mg/dL), and elevated LDH (1000 IU/L), reflecting the acidic, metabolically active environment of infection. […] Advanced diagnostic techniques may be necessary when initial fluid analysis and imaging fail to provide a definitive diagnosis.

• #8 Empyema Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/355892-overview

  Standard 2-view chest radiography remains the first study for evaluating effusion or empyema. If an effusion is present, bilateral decubitus imaging is indicated for further characterization. […] On the chest radiograph, findings that suggest empyema, as opposed to lung abscess, include extension of the air-fluid level to the chest wall, extension of the air-fluid level across fissure lines, and a tapering border of the air-fluid collection. […] Chest CT provides the most information. CT imaging depicts fluid, loculation, and thickening of the pleural membranes. […] In patients with complex fluid collections, chest CT imaging has emerged as the study of choice. […] The split pleura sign has a high diagnostic value for empyema. […] The American Association for Thoracic Surgery (AATS) consensus guidelines for the management of empyema includes the following imaging recommendations: Pleural ultrasound should be performed routinely in addition to conventional chest x-ray in the evaluation of pleural space infection, both for diagnostic purposes and for image-guidance for pleural interventions.

• #9 Empyema Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/355892-overview

  Standard 2-view chest radiography remains the first study for evaluating effusion or empyema. If an effusion is present, bilateral decubitus imaging is indicated for further characterization. […] On the chest radiograph, findings that suggest empyema, as opposed to lung abscess, include extension of the air-fluid level to the chest wall, extension of the air-fluid level across fissure lines, and a tapering border of the air-fluid collection. […] Chest CT provides the most information. CT imaging depicts fluid, loculation, and thickening of the pleural membranes. […] In patients with complex fluid collections, chest CT imaging has emerged as the study of choice. […] The split pleura sign has a high diagnostic value for empyema. […] The American Association for Thoracic Surgery (AATS) consensus guidelines for the management of empyema includes the following imaging recommendations: Pleural ultrasound should be performed routinely in addition to conventional chest x-ray in the evaluation of pleural space infection, both for diagnostic purposes and for image-guidance for pleural interventions.

• #10 Empyema Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/355892-overview

  Standard 2-view chest radiography remains the first study for evaluating effusion or empyema. If an effusion is present, bilateral decubitus imaging is indicated for further characterization. […] On the chest radiograph, findings that suggest empyema, as opposed to lung abscess, include extension of the air-fluid level to the chest wall, extension of the air-fluid level across fissure lines, and a tapering border of the air-fluid collection. […] Chest CT provides the most information. CT imaging depicts fluid, loculation, and thickening of the pleural membranes. […] In patients with complex fluid collections, chest CT imaging has emerged as the study of choice. […] The split pleura sign has a high diagnostic value for empyema. […] The American Association for Thoracic Surgery (AATS) consensus guidelines for the management of empyema includes the following imaging recommendations: Pleural ultrasound should be performed routinely in addition to conventional chest x-ray in the evaluation of pleural space infection, both for diagnostic purposes and for image-guidance for pleural interventions.

• #11 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Empyema-Diagnosis.aspx

  If an effusion is suspected with x-ray evaluation, an ultrasound is typically conducted. […] A CT scan is performed with intravenous (IV) contrast to enhance the pleura. This helps differentiate lung abscess from empyema and transudate from exudate. […] To guide the management of parapneumonic pleural effusion, diagnostic thoracentesis is performed. Thoracentesis is a valuable procedure that enables a fluid sample to be obtained for differentiating transudate from the exudate and allowing the removal of the fluid in a patient with a large volume of effusion for symptomatic relief. […] The obtained fluid is then sent for analysis and culture. The pleural fluid is subject to microbiological analysis using gram staining with cultures, pleural fluid total and differential cell count, biochemical analysis which reveals the total protein, lactate dehydrogenase, glucose, and pH; and pleural fluid biomarkers which include biomarkers of infection for example C reactive protein which I used to distinguish complicated parapneumonic pleural effusions from uncomplicated parapneumonic pleural effusions.

• #12 Pulmonary Empyema | Quirónsalud

  https://www.quironsalud.com/en/diseases-symptoms/pulmonary-empyema

  Pulmonary empyema is the presence of purulent material in the pleural cavity as a consequence of its infection. […] Pulmonary empyema is usually diagnosed and treated by specialists in pulmonology and thoracic surgery. […] A proper anamnesis and physical examination are necessary to guide the diagnosis and subsequent complementary tests. […] The pillars of imaging diagnosis for empyema are chest X-ray, ultrasound, and computed tomography (CT). […] Chest X-ray: Reveals significant pleural effusions but is often difficult to distinguish between empyema or pneumonia. […] Ultrasound: Determines the volume and is more sensitive in characterizing the type of fluid by observing septa (fibrin in the effusion) or loculations (fluid collections that do not communicate), characteristic of complicated pleural effusions and empyemas.

• #13 Pleural empyema differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Pleural_empyema_differential_diagnosis

  On examination, the following findings may be seen: Lateral chest wall swelling and tenderness, clubbing of the fingernails, dull percussion note, reduced breath sounds on the affected side of the chest, egophony, coarse crackles, increased tactile fremitus, mediastinal shift to opposite side with large empyema. […] Chest X ray of empyema shows air-fluid level continuos homogenous pattern from the mediastinum to the chest wall forming obtuse angle with the lung parenchyma. […] Ultrasound in empyema is positive for suspended microbubble sign, air fluid level, curtains sign and loss of gliding sign. […] Seen as a lung mass whose cavity is regular with smooth and regular lumen, well-defined boundary and shape changes with change in patient’s position. The split pleura sign is present (most reliable sign to differentiate empyema from lung abscess).

• #14 Empyema Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/355892-overview

  CT of the chest should be obtained when pleural space infection is suspected. […] Empyema is not diagnosed strictly on the basis of traditional radiographic findings. Further imaging with CT and confirmation of pleural infection with thoracentesis are usually required to diagnose empyema. […] The diagnosis of empyema is not based solely on ultrasonographic results. Loculated effusions suggest empyema in the proper clinical context, but the diagnosis must be confirmed with thoracentesis.

• #15 Empyema Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/355892-overview

  Standard 2-view chest radiography remains the first study for evaluating effusion or empyema. If an effusion is present, bilateral decubitus imaging is indicated for further characterization. […] On the chest radiograph, findings that suggest empyema, as opposed to lung abscess, include extension of the air-fluid level to the chest wall, extension of the air-fluid level across fissure lines, and a tapering border of the air-fluid collection. […] Chest CT provides the most information. CT imaging depicts fluid, loculation, and thickening of the pleural membranes. […] In patients with complex fluid collections, chest CT imaging has emerged as the study of choice. […] The split pleura sign has a high diagnostic value for empyema. […] The American Association for Thoracic Surgery (AATS) consensus guidelines for the management of empyema includes the following imaging recommendations: Pleural ultrasound should be performed routinely in addition to conventional chest x-ray in the evaluation of pleural space infection, both for diagnostic purposes and for image-guidance for pleural interventions.

• #16 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Empyema-Diagnosis.aspx

  If an effusion is suspected with x-ray evaluation, an ultrasound is typically conducted. […] A CT scan is performed with intravenous (IV) contrast to enhance the pleura. This helps differentiate lung abscess from empyema and transudate from exudate. […] To guide the management of parapneumonic pleural effusion, diagnostic thoracentesis is performed. Thoracentesis is a valuable procedure that enables a fluid sample to be obtained for differentiating transudate from the exudate and allowing the removal of the fluid in a patient with a large volume of effusion for symptomatic relief. […] The obtained fluid is then sent for analysis and culture. The pleural fluid is subject to microbiological analysis using gram staining with cultures, pleural fluid total and differential cell count, biochemical analysis which reveals the total protein, lactate dehydrogenase, glucose, and pH; and pleural fluid biomarkers which include biomarkers of infection for example C reactive protein which I used to distinguish complicated parapneumonic pleural effusions from uncomplicated parapneumonic pleural effusions.

• #17 Pleural empyema differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Pleural_empyema_differential_diagnosis

  Empyema must be diffrentiated from pneumonia, lung abscess, lung cancer and parapneumonic effusions on the basis of the presentation, physical examination findings, chest xray, ultrasound and CT scan findings. […] Again empyema is differentiated from a lung abscess in that empyema on CT scan is seen as a lung mass whose cavity is regular with smooth well-defined boundary and shape changes with change in patient’s position. The split pleura sign is present (most reliable sign to differentiate empyema from lung abscess). […] The pleural fluid typically has a low pH (7.20), low glucose (60 mg/dL), and contains infectious organisms. Therefore, the diagnosis relies on the presence of pus or organisms on gram stain. A positive bacteria culture from pleural fluid is not needed to make diagnosis of empyema.

• #18 Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis

  https://www.mdpi.com/2313-433X/8/1/3

  From 119 overlapping descriptors, five informative CT findings were identified: Pleural enhancement, thickening, loculation, fat thickening, and fat stranding with an AUC of 0.80 (hierarchical summary receiver operating characteristic, HSROC). […] Sensitivities for informative pleural findings independent of negative collective were 84% (95% CI 62–94) for pleural enhancement, 68% (95% CI 56–77) for pleural thickening, 52% (95% CI 44–59%) for loculation, 53% (95% CI 47–60) for fat thickening, and 39% (95% CI 32–48) for fat stranding, with corresponding specificities of 83% (95% CI 75–89), 87% (95% CI 80–92), 89% (95% CI 82–94), 91% (95% CI 72–96), and 97% (95% CI 94–98), respectively. […] The „split pleura sign” as a specific threshold for pleural enhancement was explicitly addressed in 2 studies with a pooled sensitivity of 68% (95% CI 51–81) and a specificity of 83% (95% CI 71–91). […] Our study concludes that an early diagnosis depends on a high index of suspicion. Combined with the presence of one (or more) of the several aforementioned informative pleural findings, the diagnosis of pleural empyema can be made with high specificity.

• #19 Diagnostic Accuracy of Imaging Findings in Pleural Empyema: Systematic Review and Meta-Analysis

  https://www.mdpi.com/2313-433X/8/1/3

  From 119 overlapping descriptors, five informative CT findings were identified: Pleural enhancement, thickening, loculation, fat thickening, and fat stranding with an AUC of 0.80 (hierarchical summary receiver operating characteristic, HSROC). […] Sensitivities for informative pleural findings independent of negative collective were 84% (95% CI 62–94) for pleural enhancement, 68% (95% CI 56–77) for pleural thickening, 52% (95% CI 44–59%) for loculation, 53% (95% CI 47–60) for fat thickening, and 39% (95% CI 32–48) for fat stranding, with corresponding specificities of 83% (95% CI 75–89), 87% (95% CI 80–92), 89% (95% CI 82–94), 91% (95% CI 72–96), and 97% (95% CI 94–98), respectively. […] The „split pleura sign” as a specific threshold for pleural enhancement was explicitly addressed in 2 studies with a pooled sensitivity of 68% (95% CI 51–81) and a specificity of 83% (95% CI 71–91). […] Our study concludes that an early diagnosis depends on a high index of suspicion. Combined with the presence of one (or more) of the several aforementioned informative pleural findings, the diagnosis of pleural empyema can be made with high specificity.

• #20 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  AATS recommends diagnostic thoracentesis with ultrasonography guidance in all cases of suspected parapneumonic effusion with pleural fluid thickness of more than 1 cm on chest radiography and more than 2 cm on CT. […] The most common causes are as follows: Congestive heart failure; Cancer; Bacterial pneumonia; and Pulmonary embolism.

• #21 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Chest imaging is a cornerstone of empyema diagnosis and management as it provides critical information about pleural infections’ presence, extent, and nature. […] Diagnostic fluid sampling via thoracentesis is essential in evaluating pleural effusions associated with pneumonia, recent chest trauma, surgery, or ongoing sepsis, particularly when effusion depth exceeds 2 cm on lateral decubitus films or CT. […] Pleural fluid analysis begins with assessing appearance, as grossly purulent fluid strongly suggests empyema. Biochemical markers are also crucial, with empyema typically characterized by low pH (7.2), low glucose (60 mg/dL), and elevated LDH (1000 IU/L), reflecting the acidic, metabolically active environment of infection. […] Advanced diagnostic techniques may be necessary when initial fluid analysis and imaging fail to provide a definitive diagnosis.

• #22 Empyema – WikEM

  https://wikem.org/wiki/Empyema

  Aspiracja grubo ropnej płynnej w opłucnej podczas torakocentezy i przynajmniej 1 z następujących: […] + Gram stain lub hodowla […] WBC count 50,000 cells/L (lub liczba leukocytów polimorfonuklearnych 1,000 IU/dL) […] Płyn opłucnowy glukoza 60 […] pH 7.2 […] LDH 1000 IU/mL […] Empyema […] Grube ropne.

• #23 Empyema | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/empyema/

  Defined as a collection of pus in the thoracic cavity arising from infection in the pleural space, empyema is most commonly caused by bacterial pneumonia and the resulting accumulation of fluid (parapneumonic effusion) in the pleural space. […] Prompt diagnosis and drainage of pleural space infection are critical in the treatment and management of empyema. […] The diagnosis of empyema is confirmed by the presence of pus, positive Gram stain, or culture in the pleural fluid. […] AATS recommends pleural fluid analysis for all patients showing symptoms of pneumonia or unexplained sepsis as well as for patients whose pneumonia does not respond to antibiotic therapy. […] To identify a pleural space infection, AATS recommends the use of chest radiography. […] If pleural space infection is suspected, computed tomography (CT) of the chest is recommended.

• #24 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Empyema-Diagnosis.aspx

  If an effusion is suspected with x-ray evaluation, an ultrasound is typically conducted. […] A CT scan is performed with intravenous (IV) contrast to enhance the pleura. This helps differentiate lung abscess from empyema and transudate from exudate. […] To guide the management of parapneumonic pleural effusion, diagnostic thoracentesis is performed. Thoracentesis is a valuable procedure that enables a fluid sample to be obtained for differentiating transudate from the exudate and allowing the removal of the fluid in a patient with a large volume of effusion for symptomatic relief. […] The obtained fluid is then sent for analysis and culture. The pleural fluid is subject to microbiological analysis using gram staining with cultures, pleural fluid total and differential cell count, biochemical analysis which reveals the total protein, lactate dehydrogenase, glucose, and pH; and pleural fluid biomarkers which include biomarkers of infection for example C reactive protein which I used to distinguish complicated parapneumonic pleural effusions from uncomplicated parapneumonic pleural effusions.

• #25 Pleural empyema – Wikipedia

  https://en.wikipedia.org/wiki/Pleural_empyema

  It should however be noted that the micro-organism responsible for development of empyema is not necessarily the same as the organism causing the pneumonia, especially in adults. […] It has been shown that culture yield can be increased from 44% to 69% if pleural fluid is injected into blood culture bottles (aerobic and anaerobic) immediately after aspiration. […] Furthermore, diagnostic rates can be improved for specific pathogens using polymerase chain reaction or antigen detection, especially for Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. […] Pneumococcal antigen detection in pleural fluid samples by latex agglutination can also be useful for rapid diagnosis of pneumococcal empyema.

• #26 Empyema – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1008

  1st investigations to order include blood cultures, CRP, WBC count, metabolic panel, chest x-ray, thoracic ultrasound, and thoracentesis with various analyses of pleural fluid. […] Investigations to consider include contrast-enhanced thoracic CT, MRI of thorax, PET scan, and pleural fluid polymerase chain reaction (PCR).

• #27 Empyema | Parkview Health

  https://www.parkview.com/medical-services/infectious-disease/conditions/empyema

  Blood tests can help check your white blood cell count, look for the C-reactive protein, and identify the bacteria causing the infection. White cell count can be elevated when you have an infection. […] During a thoracentesis, a needle is inserted through the back of your ribcage into the pleural space to take a sample of fluid. The fluid is then analyzed under a microscope to look for bacteria, protein, and other cells.

• #28 Diagnosis and management of pleural infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10790177/

  Pleural fluid sampling remains the gold standard for diagnosis of pleural infection. Macroscopically purulent pleural fluid, or empyema, is diagnostic of pleural infection and no further pleural fluid analysis is required. Immediate management with intercostal drainage is recommended. […] Recent investigative research into pleural fluid biomarkers has revealed two promising novel entities, namely soluble urokinase plasminogen activator receptor (suPAR) and plasminogen activator inhibitor (PAI)-1. […] Pleural fluid culture, to date, is the recommended modality for microbiology. Although it has a yield of 30-40%, this increases to 60% when inoculated into blood culture bottles. […] The RAPID score was derived and validated in the MIST-1 and MIST-2 cohort studies, respectively. The score is based on five baseline parameters: serum urea (Renal), patient Age, pleural fluid Purulence, Infection source (community- versus healthcare-acquired infection) and serum albumin (Dietary). This score has been validated prospectively and externally in the PILOT study, which demonstrated that low-risk patients (RAPID score 0-2) had a 3-month mortality of 2.3%, medium-risk (RAPID score 3-4) had 9.2% mortality and high-risk (RAPID score 5-7) had 29.3% mortality.

• #29 Diagnosis and management of pleural infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10790177/

  Pleural fluid sampling remains the gold standard for diagnosis of pleural infection. Macroscopically purulent pleural fluid, or empyema, is diagnostic of pleural infection and no further pleural fluid analysis is required. Immediate management with intercostal drainage is recommended. […] Recent investigative research into pleural fluid biomarkers has revealed two promising novel entities, namely soluble urokinase plasminogen activator receptor (suPAR) and plasminogen activator inhibitor (PAI)-1. […] Pleural fluid culture, to date, is the recommended modality for microbiology. Although it has a yield of 30-40%, this increases to 60% when inoculated into blood culture bottles. […] The RAPID score was derived and validated in the MIST-1 and MIST-2 cohort studies, respectively. The score is based on five baseline parameters: serum urea (Renal), patient Age, pleural fluid Purulence, Infection source (community- versus healthcare-acquired infection) and serum albumin (Dietary). This score has been validated prospectively and externally in the PILOT study, which demonstrated that low-risk patients (RAPID score 0-2) had a 3-month mortality of 2.3%, medium-risk (RAPID score 3-4) had 9.2% mortality and high-risk (RAPID score 5-7) had 29.3% mortality.

• #30 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Chest imaging is a cornerstone of empyema diagnosis and management as it provides critical information about pleural infections’ presence, extent, and nature. […] Diagnostic fluid sampling via thoracentesis is essential in evaluating pleural effusions associated with pneumonia, recent chest trauma, surgery, or ongoing sepsis, particularly when effusion depth exceeds 2 cm on lateral decubitus films or CT. […] Pleural fluid analysis begins with assessing appearance, as grossly purulent fluid strongly suggests empyema. Biochemical markers are also crucial, with empyema typically characterized by low pH (7.2), low glucose (60 mg/dL), and elevated LDH (1000 IU/L), reflecting the acidic, metabolically active environment of infection. […] Advanced diagnostic techniques may be necessary when initial fluid analysis and imaging fail to provide a definitive diagnosis.

• #31 Empyema – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/1008

  1st investigations to order include blood cultures, CRP, WBC count, metabolic panel, chest x-ray, thoracic ultrasound, and thoracentesis with various analyses of pleural fluid. […] Investigations to consider include contrast-enhanced thoracic CT, MRI of thorax, PET scan, and pleural fluid polymerase chain reaction (PCR).

• #32 Pleural empyema – Wikipedia

  https://en.wikipedia.org/wiki/Pleural_empyema

  It should however be noted that the micro-organism responsible for development of empyema is not necessarily the same as the organism causing the pneumonia, especially in adults. […] It has been shown that culture yield can be increased from 44% to 69% if pleural fluid is injected into blood culture bottles (aerobic and anaerobic) immediately after aspiration. […] Furthermore, diagnostic rates can be improved for specific pathogens using polymerase chain reaction or antigen detection, especially for Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. […] Pneumococcal antigen detection in pleural fluid samples by latex agglutination can also be useful for rapid diagnosis of pneumococcal empyema.

• #33 Pleural empyema – Wikipedia

  https://en.wikipedia.org/wiki/Pleural_empyema

  It should however be noted that the micro-organism responsible for development of empyema is not necessarily the same as the organism causing the pneumonia, especially in adults. […] It has been shown that culture yield can be increased from 44% to 69% if pleural fluid is injected into blood culture bottles (aerobic and anaerobic) immediately after aspiration. […] Furthermore, diagnostic rates can be improved for specific pathogens using polymerase chain reaction or antigen detection, especially for Streptococcus pneumoniae, Streptococcus pyogenes and Staphylococcus aureus. […] Pneumococcal antigen detection in pleural fluid samples by latex agglutination can also be useful for rapid diagnosis of pneumococcal empyema.

• #34 Empyema and Abscess Pneumonia Differential Diagnoses

  https://emedicine.medscape.com/article/807499-differential

  Pleural empyema can be distinguished from lung abscess by using computed tomography scanning or ultrasonography. […] Other conditions to consider include excavating tuberculosis and mycosis, and pulmonary cystic lesions. […] Excavating bronchial carcinomas have a thicker and irregular wall compared to infectious lung abscess.

• #35 Pleural empyema differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Pleural_empyema_differential_diagnosis

  Empyema must be diffrentiated from pneumonia, lung abscess, lung cancer and parapneumonic effusions on the basis of the presentation, physical examination findings, chest xray, ultrasound and CT scan findings. […] Again empyema is differentiated from a lung abscess in that empyema on CT scan is seen as a lung mass whose cavity is regular with smooth well-defined boundary and shape changes with change in patient’s position. The split pleura sign is present (most reliable sign to differentiate empyema from lung abscess). […] The pleural fluid typically has a low pH (7.20), low glucose (60 mg/dL), and contains infectious organisms. Therefore, the diagnosis relies on the presence of pus or organisms on gram stain. A positive bacteria culture from pleural fluid is not needed to make diagnosis of empyema.

• #36 Empyema and Abscess Pneumonia Differential Diagnoses

  https://emedicine.medscape.com/article/807499-differential

  Pleural empyema can be distinguished from lung abscess by using computed tomography scanning or ultrasonography. […] Other conditions to consider include excavating tuberculosis and mycosis, and pulmonary cystic lesions. […] Excavating bronchial carcinomas have a thicker and irregular wall compared to infectious lung abscess.

• #37 Pleural empyema differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Pleural_empyema_differential_diagnosis

  On examination, the following findings may be seen: Lateral chest wall swelling and tenderness, clubbing of the fingernails, dull percussion note, reduced breath sounds on the affected side of the chest, egophony, coarse crackles, increased tactile fremitus, mediastinal shift to opposite side with large empyema. […] Chest X ray of empyema shows air-fluid level continuos homogenous pattern from the mediastinum to the chest wall forming obtuse angle with the lung parenchyma. […] Ultrasound in empyema is positive for suspended microbubble sign, air fluid level, curtains sign and loss of gliding sign. […] Seen as a lung mass whose cavity is regular with smooth and regular lumen, well-defined boundary and shape changes with change in patient’s position. The split pleura sign is present (most reliable sign to differentiate empyema from lung abscess).

• #38 Thoracic Empyema | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27359

  Thoracic empyema, defined by the presence of frank purulent exudate in the pleural space, is an infectious and life-threatening condition with a long history. […] Prompt diagnosis and intervention are crucial for improving patient outcomes, as treatment hinges on integrating medical and surgical strategies to eradicate the infection and facilitate lung reexpansion. […] Together, these factors underscore the need for refined diagnostic and treatment strategies to improve patient outcomes and alleviate the economic impact of thoracic empyema. […] The development of pleural space infections likely involves increased permeability of the mesothelial layer of the inflamed pleurae, allowing bacteria to invade the typically sterile space. […] Despite these varied mechanisms, the most common etiologic pathway involves the aspiration of organisms from the oropharynx, leading to pneumonia in the dependent lobes, which, if left untreated, can progress to parapneumonic effusion and, ultimately, empyema.

• #39 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Thoracic empyema, characterized by the presence of purulent fluid in the pleural space, remains a significant clinical challenge with considerable morbidity and mortality. […] Early diagnosis and aggressive management, including antimicrobial therapy, drainage procedures, and sometimes surgery, are critical for favorable outcomes. Diagnostic strategies hinge on imaging and pleural fluid analysis, while treatment aims to eradicate infection, facilitate lung reexpansion, and prevent long-term complications. […] Recognizing the early signs of pleural space infections, differentiating empyema from other pleural conditions, and employing advanced diagnostic and therapeutic techniques facilitate improved outcomes. […] Prompt diagnosis and intervention are crucial for improving patient outcomes, as treatment hinges on integrating medical and surgical strategies to eradicate the infection and facilitate lung reexpansion.

• #40 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Thoracic empyema, characterized by the presence of purulent fluid in the pleural space, remains a significant clinical challenge with considerable morbidity and mortality. […] Early diagnosis and aggressive management, including antimicrobial therapy, drainage procedures, and sometimes surgery, are critical for favorable outcomes. Diagnostic strategies hinge on imaging and pleural fluid analysis, while treatment aims to eradicate infection, facilitate lung reexpansion, and prevent long-term complications. […] Recognizing the early signs of pleural space infections, differentiating empyema from other pleural conditions, and employing advanced diagnostic and therapeutic techniques facilitate improved outcomes. […] Prompt diagnosis and intervention are crucial for improving patient outcomes, as treatment hinges on integrating medical and surgical strategies to eradicate the infection and facilitate lung reexpansion.

• #41 Thoracic Empyema | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27359

  Frank pus in the pleural space necessitates surgical drainage. […] Microbiological evaluation includes Gram staining for immediate organism identification and pleural fluid cultures for definitive diagnosis. […] Blood cultures are necessary for any patient with empyema. […] Advanced diagnostic techniques may be necessary when initial fluid analysis and imaging fail to provide a definitive diagnosis. […] The treatment and management of thoracic empyema involve a combination of medical and surgical interventions aimed at eradicating infection, achieving adequate drainage of the pleural space, and restoring lung function. […] Empiric broad-spectrum antibiotics are necessary for most patients with suspected or confirmed empyema. […] Chest tube placement under radiologic guidance remains the cornerstone nonsurgical intervention for empyema.

• #42 Thoracic Empyema | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27359

  Frank pus in the pleural space necessitates surgical drainage. […] Microbiological evaluation includes Gram staining for immediate organism identification and pleural fluid cultures for definitive diagnosis. […] Blood cultures are necessary for any patient with empyema. […] Advanced diagnostic techniques may be necessary when initial fluid analysis and imaging fail to provide a definitive diagnosis. […] The treatment and management of thoracic empyema involve a combination of medical and surgical interventions aimed at eradicating infection, achieving adequate drainage of the pleural space, and restoring lung function. […] Empiric broad-spectrum antibiotics are necessary for most patients with suspected or confirmed empyema. […] Chest tube placement under radiologic guidance remains the cornerstone nonsurgical intervention for empyema.

• #43 Thoracic Empyema | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27359

  Surgical consultation should be a consideration when drainage via tube thoracostomy fails or for patients with multiloculated empyema. […] Effective management requires an interdisciplinary team of healthcare professionals involving pulmonologists, thoracic surgeons, infectious disease specialists, radiologists, and nursing staff.

• #44 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  The treatment and management of thoracic empyema involve a combination of medical and surgical interventions aimed at eradicating infection, achieving adequate drainage of the pleural space, and restoring lung function. Early and aggressive management is critical to improving outcomes and minimizing complications. […] Surgical consultation should be a consideration when drainage via tube thoracostomy fails or for patients with multiloculated empyema. […] Effective management requires an interdisciplinary team of healthcare professionals involving pulmonologists, thoracic surgeons, infectious disease specialists, radiologists, and nursing staff. Coordination ensures timely diagnosis, proper drainage procedures, and individualized treatment plans.

• #45 Thoracic Empyema – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544279/

  Thoracic empyema, characterized by the presence of purulent fluid in the pleural space, remains a significant clinical challenge with considerable morbidity and mortality. […] Early diagnosis and aggressive management, including antimicrobial therapy, drainage procedures, and sometimes surgery, are critical for favorable outcomes. Diagnostic strategies hinge on imaging and pleural fluid analysis, while treatment aims to eradicate infection, facilitate lung reexpansion, and prevent long-term complications. […] Recognizing the early signs of pleural space infections, differentiating empyema from other pleural conditions, and employing advanced diagnostic and therapeutic techniques facilitate improved outcomes. […] Prompt diagnosis and intervention are crucial for improving patient outcomes, as treatment hinges on integrating medical and surgical strategies to eradicate the infection and facilitate lung reexpansion.

• #46 Diagnosis and management of pleural infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10790177/

  Pleural fluid sampling remains the gold standard for diagnosis of pleural infection. Macroscopically purulent pleural fluid, or empyema, is diagnostic of pleural infection and no further pleural fluid analysis is required. Immediate management with intercostal drainage is recommended. […] Recent investigative research into pleural fluid biomarkers has revealed two promising novel entities, namely soluble urokinase plasminogen activator receptor (suPAR) and plasminogen activator inhibitor (PAI)-1. […] Pleural fluid culture, to date, is the recommended modality for microbiology. Although it has a yield of 30-40%, this increases to 60% when inoculated into blood culture bottles. […] The RAPID score was derived and validated in the MIST-1 and MIST-2 cohort studies, respectively. The score is based on five baseline parameters: serum urea (Renal), patient Age, pleural fluid Purulence, Infection source (community- versus healthcare-acquired infection) and serum albumin (Dietary). This score has been validated prospectively and externally in the PILOT study, which demonstrated that low-risk patients (RAPID score 0-2) had a 3-month mortality of 2.3%, medium-risk (RAPID score 3-4) had 9.2% mortality and high-risk (RAPID score 5-7) had 29.3% mortality.

• #47 Combined serum biomarkers in the noninvasive diagnosis of complicated parapneumonic effusions and empyema | BMC Pulmonary Medicine | Full Text

  https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-019-0877-8

  We previously demonstrated that the pleural levels of proteins (neutrophil gelatinase-associated lipocalin/NGAL, calprotectin, bactericidal permeability-increasing/BPI, azurocidin 1/AZU-1) were valuable markers for identifying complicated PPE (CPPE). Herein, this study was performed to evaluate whether these proteins are useful as serological markers for identifying CPPE and empyema. […] The serum levels of NGAL, calprotectin, and BPI in PPE patients were significantly higher than those in transudates, noninfectious exudates, and healthy controls. […] In PPE group, serum NGAL and calprotectin levels were significantly elevated in patients with CPPE and empyema than in those with UPPE, whereas the serum BPI levels were similar between these two groups. […] We concluded that serum calprotectin and NGAL were adjuvant serological markers for CPPE and empyema diagnosis. […] The combination of serum calprotectin and CRP constitutes a more highly sensitive and specific assay for identifying CPPE and empyema.

• #48 Pleural empyema differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Pleural_empyema_differential_diagnosis

  Empyema must be diffrentiated from pneumonia, lung abscess, lung cancer and parapneumonic effusions on the basis of the presentation, physical examination findings, chest xray, ultrasound and CT scan findings. […] Again empyema is differentiated from a lung abscess in that empyema on CT scan is seen as a lung mass whose cavity is regular with smooth well-defined boundary and shape changes with change in patient’s position. The split pleura sign is present (most reliable sign to differentiate empyema from lung abscess). […] The pleural fluid typically has a low pH (7.20), low glucose (60 mg/dL), and contains infectious organisms. Therefore, the diagnosis relies on the presence of pus or organisms on gram stain. A positive bacteria culture from pleural fluid is not needed to make diagnosis of empyema.

• #49 Diagnosis and management of pleural infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10790177/

  Pleural infection remains a medical challenge. Diagnosis presents challenges due to non-specific clinical presenting features. Imaging techniques such as chest radiographs, thoracic ultrasound and computed tomography scans aid diagnosis. Pleural fluid analysis, the gold standard, involves assessing gross appearance, biochemical markers and microbiology. Novel biomarkers such as suPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor-1) show promise in diagnosis and prognosis, and microbiology demonstrates complex microbial diversity and is associated with outcomes. […] Clinical presentation of pleural infection is non-specific and variable; therefore, early diagnosis can be challenging. Several risk factors, such as immunosuppression, diabetes, poor oral hygiene, gastro-oesophageal reflux, alcohol excess and intravenous drug use, are known to independently predict increased risk of progression of pneumonia to pleural infection. However, there are currently no validated clinical risk prediction tools that predict the development of pleural infection from pneumonia. A reliable prediction tool for parapneumonic effusion and pleural infection in patients with pneumonia would allow identification of patients that are at high risk of developing these conditions, thereby allowing close monitoring of this group and, therefore, early detection and management to improve outcomes.

• #50 Thoracic Empyema | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27359

  Thoracic empyema, defined by the presence of frank purulent exudate in the pleural space, is an infectious and life-threatening condition with a long history. […] Prompt diagnosis and intervention are crucial for improving patient outcomes, as treatment hinges on integrating medical and surgical strategies to eradicate the infection and facilitate lung reexpansion. […] Together, these factors underscore the need for refined diagnostic and treatment strategies to improve patient outcomes and alleviate the economic impact of thoracic empyema. […] The development of pleural space infections likely involves increased permeability of the mesothelial layer of the inflamed pleurae, allowing bacteria to invade the typically sterile space. […] Despite these varied mechanisms, the most common etiologic pathway involves the aspiration of organisms from the oropharynx, leading to pneumonia in the dependent lobes, which, if left untreated, can progress to parapneumonic effusion and, ultimately, empyema.

• #51 Diagnosis and management of pleural infection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10790177/

  Pleural infection remains a medical challenge. Diagnosis presents challenges due to non-specific clinical presenting features. Imaging techniques such as chest radiographs, thoracic ultrasound and computed tomography scans aid diagnosis. Pleural fluid analysis, the gold standard, involves assessing gross appearance, biochemical markers and microbiology. Novel biomarkers such as suPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor-1) show promise in diagnosis and prognosis, and microbiology demonstrates complex microbial diversity and is associated with outcomes. […] Clinical presentation of pleural infection is non-specific and variable; therefore, early diagnosis can be challenging. Several risk factors, such as immunosuppression, diabetes, poor oral hygiene, gastro-oesophageal reflux, alcohol excess and intravenous drug use, are known to independently predict increased risk of progression of pneumonia to pleural infection. However, there are currently no validated clinical risk prediction tools that predict the development of pleural infection from pneumonia. A reliable prediction tool for parapneumonic effusion and pleural infection in patients with pneumonia would allow identification of patients that are at high risk of developing these conditions, thereby allowing close monitoring of this group and, therefore, early detection and management to improve outcomes.

Zobacz więcej