Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T06:21:35.311Z Has data issue: false hasContentIssue false

35 - Empyema and Bronchopleural Fistula

from Part V - Clinical Syndromes – Respiratory Tract

Published online by Cambridge University Press:  05 March 2013

Charlotte E. Bolton
Affiliation:
Cardiff University
Dennis J. Shale
Affiliation:
Cardiff University
David Schlossberg
Affiliation:
Temple University School of Medicine, Philadelphia
Get access

Summary

Infection of the pleural space leading to empyema formation, and the importance of clearing infection and pus from this space, has been recognized since ancient times. Historically, empyema was associated with pneumococcal pneumonia, with Streptococcus pneumoniae causing up to 70% of pleural space infections. With effective antibiotic treatment for pneumonia, the incidence of empyema has decreased markedly, and the spectrum of causative organisms has widened, with S. pneumoniae now accounting for as few as 10% to 20%. However, parapneumonic effusions occur in 30% to 60% of pneumonia cases, and, when empyema occurs, it is associated with an overall mortality of 20%.

Parapneumonic effusions are classified as simple or uncomplicated, complicated, and empyema, based on the appearance and biochemical characteristics of aspirated fluid, which supports the clinical impression of a continuum of disease (Table 35.1).

This classification also has clinical utility in that, during the early acute phase, with free flowing fluid, treatment is simpler than in the more chronic fibropurulent stage associated with multiple loculations and the need for greater interventional therapy. Empyema may be defined as the presence of organisms and numerous host defense cells, neutrophils, in the pleural fluid, or, more narrowly, as pus apparent to the naked eye. Bronchopleural fistula (BPF) may be caused by an empyema or may be associated with empyema following surgery, penetrating lung injuries, or a lung abscess.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×