empyema thoracis  

classification

- type of pleural effusion

- type of empyema thoracis

 

type of pleural effusion

- simple self-resolving parapneumonic pleural effusion

- complicated multiloculated fibropurulent collection

 

type of empyema thoracis

- primary empyema

- secondaary empyema

pathophysiology

- stage of empyema thoracis

stage of empyema thoracis

- exudative phase >> pleural membrane swelling with discharge

- fibrinopurulent phase >> bacteria invade the effusion

- organizatoin phase >> fibrosis at fibrin (7-10 d)

investigation

- pleural fluid thoracentesis

- hemoculture

- CXR

- ultrasound

- CT chest

- bronchoscopy

 

pleural fluid thoracentesis

- indication pleural fluid thoracentesis

indication pleural fluid thoracentesis

- pleural thickening > 10 mm depth

- increase in size

- ongoing sepsis

hemoculture

- indication hemoculture

indication hemoculture

- suspected pleural infection

ultrasound

- finding of ultrasound

finding of ultrasound

** anechoic pleural effusion with septae

** echogenic pleural effusion with lung atelectasis

CT chest

- finding of CT chest

finding of CT chest

bronchoscopy

- indication bronchoscopy

indication bronchoscopy

- high index of suspicion of bronchial obstruction

diagnosis

- diagnosis of empyema thoracis

diagnosis of empyema thoracis

- pH 7.21-7.29

- low glucose < 50 mg/dL

- high LDH > 1,000 IU/L

treatment

- หลักการรักษา empyema thoracis

- conservative Rx

- surgery

หลักการรักษา empyema thoracis

conservative Rx

- แนวทางเลือกกการรักษาตาม stage of empyema thoracis

- conservative Rx มีการรักษาอะไรบ้าง

- definition of failed conservative Rx

แนวทางเลือกกการรักษาตาม stage of empyema thoracis

 

conservative Rx มีการรักษาอะไรบ้าง

- ATB

- pleural drainage

- pleurodesis

ATB

- แนวทางในการเลือกใช้ ATB

แนวทางในการเลือกใช้ ATB

pleural drainage

- indication pleural drainage

- drainage options

indication pleural drainage

- complicated effusion

- frank empyema

- pleural fluid pH < 7.2 or pH > 7.6 or pleural glucose < 3.4 mmol/L

 

drainage options

- simple thoracostomy (repeated thoracocentesis)

- pigtail catheter

repeated thoracentesis

- indication repeated thoracentesis

indication repeated thoracentesis

pleurodesis

- type of pleurodesis

type of pleurodesis

- mechanical pleurodesis

- chemical pleurodesis

chemical pleurodesis

- วิธีการรักษาด้วย chemical pleurodesis

วิธีการรักษาด้วย chemical pleurodesis

 

definition of failed conservative Rx

surgery

- indication decortication

- contraindication decortication

- technique of surgery

indication decortication

 

contraindication decortication

 

technique of surgery

- technique of approach

** VATS

** open surgery

+++ ข้อดีของ VATs ที่เหนือกว่า open surgery คือ

VATS decortication

- indication VATS decortication

- technique VATS decortication ทำอย่างไร

indication VATS decortication

 

technique VATS decortication ทำอย่างไร

open decortication

- indication open decortication

- technique of open decortication

indication open decortication

 

technique of open decortication

- a full rib resection during teh approach

- start to strip the parietal pleura from the chest wall before inserting a rib spreader

- the peel should be stripped from the lung with care using a peanut on a long artery forceps

** if the peel is adherent to the lung without an apparent plane, it can be cut in a crosshatched manner