Purulent pleurisy

Purulent pleurisy (synonym: empiema pleura, pyothorax) is the result of infection in the pleural cavity. The disease is most frequently a complication of purulent processes in the lungs or subphrenic space.

purulent pleurisy Fig. 4. Diagram of the locations of purulent pleurisy:
1 - encysted pleurisy in the sinus;
2 - mediastinal;
3 - total;
4 - majdalawi;
5 - diaphragmatic;
6 - wall;
7 - apical;
Dr. aperture.

Empiema pleura, tends to be one-sided and is located mainly in the bottom or the back of the pleural cavity, but it could be total when an entire lung atelectasis offset bodies mediastinum in the opposite direction (Fig. 4). Microbial flora in introducing pleurisy diverse: Staphylococcus, Streptococcus, pneumococcus, Mycobacterium tuberculosis and other
The clinical picture of pyogenic pleurisy is characterized by a high rise in temperature, chills, rapid pulse (up to 120 beats per 1 min), increasing shortness of breath, cyanosis, sweating, sharp pricking chest pain, aggravated by deep breathing, coughing. The rib cage on the affected side behind in the act of breathing, voice trembling weakened, breathing noises auscultation not held. In the blood by the high leukocytosis (20 000 - 30 000), with a shift leukocyte left and acceleration ROHE, often develops hypochromic anemia. In the urine protein and cylinders. The radiological examination shows decrease the transparency of the corresponding Department of the lung, in the presence of air (pyopneumothorax) is defined homogeneous shadow of the exudate with horizontal upper limit above which is visible gas.
Diagnosis of purulent pleurisy is complemented pleural puncture, which is made by a doctor. The role of the assistant is to prepare required to puncture 10 - 20-gram syringe with a long needle on the cannula which put a thin rubber tube length of 10 cm, iodine tincture, ethyl alcohol, sterile wipes and tray for sucked content. When the syringe is filled with pus, rubber tube clamp, then syringe released from pus and through the same needle is injected 200 000 UNITS of penicillin dissolved in 10 ml of physiological solution. Puncture is made with observance of all rules of aseptics: a Toolkit carefully boiled. The puncture site is often VIII or IX intercostal space between the posterior axillary and blade lines. The skin around the site is cleaned with alcohol and smeared iodine tincture. During the puncture the corresponding hand, the patient is given in the opposite direction or put on the head. If the puncture is done in a sitting position, the trunk of the patient should be slightly tilted forward.
Purulent complications of pleurisy: osteomyelitis ribs, bronchopleural fistula, a breakthrough of pus through the parietal pleura, intercostal muscles and subcutaneous tissue of the chest, and sometimes even through the skin to the outside.
The treatment of purulent pleurisy is the use of antibiotics, oxygen inhalation, the introduction of heart drugs, 40% glucose with vitamins C, B1, B2, removing effusion method pleural puncture. Conservative treatment can be effective in the initial period of the disease. More often in introducing pleurisy shown thoracotomy (see) with active aspiration of pus. For this purpose in the pleural cavity enter the drainage tube, one end of which is connected with a vacuum device (see Suction drainage). Less effective way of Bulow: drainage put in a jar with antiseptic liquid, after putting on the tube valve from a finger from rubber gloves. By decreasing the amount of pus easy to crack down. Recovery ends to 4-6 weeks. The drainage tube is removed after the liquidation of purulent cavities.
When TB pleural empyema surgical treatment [pleurectomy (see)is performed in combination with antibacterial therapy (streptomycin, PASK, ftivazide and others).
After clinical recovery patients with a history of purulent pleurisy, subject to outpatient monitoring. It is recommended that long-term use physical therapy and health resort treatment (pine forest, southern coast of Crimea is not in the hottest months of the year). Meals should be high in calories, with adequate protein and vitamins. Should be excluded of privrzenostaffecting the respiratory system.

Purulent pleurisy (synonym: pyothorax, empiema pleura) is characterized by the accumulation in mezhplevralny cracks purulent exudate. The leading etiological factor in the development of purulent effusion is penetration into the pleura of the pathogen pyogenic infections (Streptococcus, pneumococcus, Staphylococcus, and so on).
There are primary and secondary purulent pleurisy. Primary P. arise primarily because of penetrating wounds of the chest or as a complication of surgery in the chest cavity; microflora of exudate in these P. usually mixed. Perhaps lymphogenous (from the upper respiratory tract), less hematogenous (for example, when the umbilical sepsis in the newborn) the origin of purulent P. the Most common causative agent of lymphogenous P. happens pneumococcus.
Secondary P. usually arise from the spread of infection per continuitatem (at the break in the pleural cavity of lung abscess, rarely of the abscess any other localization) or metstaticski - from distant purulent and sometimes when General infectious disease (scarlet fever, typhoid fever). However, and in these cases the infection usually spreads to lymph nodes in the chest cavity, and even more in the light, and then pleurisy occurs. S. I., Spasokukotsky and F. R. Grapes-Finkel ' (1933) in 65% of cases of acute empyema found purulent process in the lung. Due to the widespread introduction of antibacterial drugs significantly reduced the frequency of purulent P. motivated inflammation of the lung. However, it should be borne in mind that in recent years cases of purulent on complications of staphylococcal abstemiously pneumonia in connection with the emergence of antibiotic-resistant species of staphylococci (see Staph infection).
Localization of pleurisy can be one - way, and on prevalence - total (pleuritis diffusa) and limited, encysted (pi. circumscripta, s. saccata). The latter in turn are divided into multi-and single-chamber, and localization on the wall (pi. costalis), apex (pi. apicalis), diaphragm, or basal (pi. diaphragmatica), parameterstyle (pi. раramediastinalis), magdalenae (pleuritis, s. abscessus, interlobaris), and so on Limited P. characterized, as a rule, the onset of a chronic course of the process.