Empyema of the pleura, it's pyotorax or purulent pleurisy - an inflammatory process of pleural leaves, accompanied by a pile of pus in the pleural cavity. The disease in more than 90% of cases is secondary and occurs when the inflammatory process passes to the pleura from the lungs, mediastinum, chest wall, pericardium, space below the diaphragm. Most often pleural empyema occurs with acute or chronic infectious diseases of the lung: pneumonia, abscesses, tuberculosis, suppuration of the cyst of the lung.
But it is also possible the emergence of empyema due to infection from distant purulent foci (for example, as a consequence of purulent appendicitis, in sepsis , angina, etc.).
Symptoms of pleural empyema
By the duration of the course of empyema, the pleura is divided into acute and chronic. Chronic is called pleural empyema, which exists for more than two months, and it arises as a result of improper treatment or some peculiarities of the course of inflammation in acute empyema.
Symptoms of acute pleural empyema are chest pain, shortness of breath, general intoxication of the body, fever to 38-39 ° C, dry or purulent sputum cough, development of respiratory failure (severe shortness of breath, tachycardia, arterial hypotension). The onset of the disease is usually acute, less often with a gradual increase in temperature and the development of pain in the chest.
With chronic empyema of the pleura is characterized by a wavy course of the disease, with periods of exacerbation and remission. Body temperature is often subfebrile. As a result of the process, pleating occurs in the pleural cavity, then tissue scarring occurs, and extensive fusion between the chest wall and the lungs is formed. Damaged pleura can significantly (up to 2 cm) thicken, preventing normal breathing and provoking respiratory pulmonary-cardiac failure.
Treatment of pleural empyema
The scheme of relief is as follows:
- It is mandatory to clean the pleural cavity of the pus, by performing a puncture or draining. The earlier the removal of pus is carried out, the faster the recovery and the less risk of complications.
- The use of antibiotics. In addition to the general course of antibiotics
In the case of severe pleurisy, the pleural cavity should be washed with liquids containing antibacterial drugs. - From other methods of treatment, vitamin therapy, detoxification and immunostimulating therapy, the introduction of protein preparations (blood plasma, albumin) are used. In addition, UVA of blood, plasmapheresis , hemosorption can be performed.
- At the stage of recovery, therapeutic exercises, massages, ultrasound and other physiotherapy are used.
- In chronic empyema, surgical treatment is usually indicated.
Treatment of this disease is usually carried out in a stationary setting.