RESUMO
Lung abscesses and empyemas are 2 forms of pulmonary infection that can present with similar clinical features. However, empyemas are associated with higher morbidity and mortality, necessitating the need to distinguish one from the other. Plain radiographs can sometimes provide clues to help differentiate the 2 pathologies but more often than not, a computed tomography scan is required to confirm the diagnosis. Correct diagnosis is essential, as the goal standard therapeutic intervention for empyemas may be contraindicated in patients with lung abscesses. Empyemas require percutaneous or surgical drainage in combination with antibiotics, while lung abscesses are generally treated with antibiotics alone as drainage can be associated with various complications. We present a case of a 65-year-old man with parapneumonic empyema diagnosed with characteristic findings on chest computed tomography and treated with surgical drainage and antibiotics. We hope to improve patient outcomes by highlighting the classical radiographic findings that help distinguish empyema and abscess.
Assuntos
Empiema , Abscesso Pulmonar , Masculino , Humanos , Idoso , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/terapia , Empiema/diagnóstico , Empiema/terapia , Empiema/complicações , Drenagem/métodos , Tomografia Computadorizada por Raios X/métodos , Antibacterianos/uso terapêuticoAssuntos
Empiema Pleural , Empiema , Derrame Pleural , Criança , Cidades , Empiema/terapia , Empiema Pleural/terapia , Humanos , Pleura , Derrame Pleural/etiologia , Derrame Pleural/terapiaRESUMO
AIM: Paediatric intensive care unit (PICU) admissions for empyema increased following the 13-valent pneumococcal conjugate vaccine (PCV13). We describe the clinical characteristics, management and outcomes for children with empyema and compare incidence before and after PCV13. METHODS: Retrospective study of patients <18 years admitted to The Royal Children's Hospital Melbourne PICU with empyema between January 2016 and July 2019. We investigated the incidence of empyema during two time periods: 2007-2010 (pre-PCV13) and 2016-2019 (post-PCV13). RESULTS: Seventy-one children (1.9% of all PICU admissions) were admitted to PICU with empyema between 2016 and 2019. Sixty-one (86%) had unilateral disease, 11 (16%) presented with shock and 44 (62%) were ventilated. Streptococcus pneumoniae and group A Streptococcus were the most commonly identified pathogens. Forty-five (63%) were managed with video-assisted thoracoscopic surgery (VATS). There was a 31% reduction in empyema hospitalisations as a proportion of all hospitalisations (IRR 0.69, 95% CI 0.59-0.8), but a 2.8-fold increase in empyema PICU admissions as a proportion of all PICU admissions (95% CI 2.2-3.5, P < 0.001). For the PICU cohort, this was accompanied by reduction in PIM2 probability of death (median 1% vs. 1.9%, P = 0.02) and duration of intubation (median 69 h vs. 126.5 h, P = 0.045). CONCLUSIONS: In children with empyema in PICU 62% required ventilation, 16% had features of shock and 63% received VATS. Empyema admissions, as a proportion of all PICU admissions, increased in the era post-PCV13 compared to pre-PCV13 despite no increase in illness severity at admission.
Assuntos
Empiema , Infecções Pneumocócicas , Criança , Empiema/epidemiologia , Empiema/etiologia , Empiema/terapia , Humanos , Incidência , Lactente , Unidades de Terapia Intensiva Pediátrica , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Estudos Retrospectivos , Streptococcus pneumoniaeRESUMO
BACKGROUND: Anastomotic leakage with empyema is one of the most severe complications of esophagectomy. We invented a new type of slow-flow irrigation drainage tube to improve the smooth pleural drainage, which contributed to the recovery of anastomotic leakage. METHODS: In this study, 42 patients, from 2012 to 2019, who underwent esophagectomy and postoperative anastomotic leakage with persistent empyema, were enrolled and distributed into irrigation drainage tube group (I+) or non-irrigation drainage tube group (I-). In (I+) group, the slow-flow irrigation drainage tube was placed along the primary pleural drainage tube into the empyema cavity, irrigated with normal saline. Clinicopathological features and perioperative complications of all patients were collected and compared to determine the differences between the two groups with statistical analysis. RESULTS: All 20 patients were distributed into (I+) group and 22 into (I-) group. The two groups were comparable in clinicopathological features. When compared with (I-) group, patients in (I+) group achieved significantly shorter healing duration and postoperative hospital stay. The complications resulting from anastomotic leakage in (I+) group were relatively fewer than those in (I-) group, including postoperative bleeding (0 vs. 1) and pulmonary complications (7 vs. 13). Moreover, 5 reoperations for rescuing bleeding or severe thoracic infection were performed in (I-) group, while none in (I+) group. CONCLUSIONS: The slow-flow irrigation drainage tube is a safe and effective treatment of anastomotic leakage and empyema. Additional prospective study is required to furtherly determine the improvement of drainage and extended application in deep infections located in thorax.
Assuntos
Empiema , Neoplasias , Fístula Anastomótica/etiologia , Fístula Anastomótica/terapia , Drenagem , Empiema/etiologia , Empiema/terapia , Junção Esofagogástrica/cirurgia , Humanos , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Estudos RetrospectivosAssuntos
Empiema/complicações , Empiema/microbiologia , Peptostreptococcus/isolamento & purificação , Pneumonia/complicações , Adulto , Antibacterianos/uso terapêutico , Drenagem/métodos , Empiema/diagnóstico por imagem , Empiema/terapia , Humanos , Masculino , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Abscesso Encefálico/terapia , Empiema/terapia , Terapia por Fagos , Infecções Estafilocócicas/terapia , Teicoplanina/análogos & derivados , Adulto , Bacteriófagos/fisiologia , Terapia Combinada , Empiema/microbiologia , Feminino , Humanos , Terapia por Fagos/métodos , Terapia de Salvação/métodos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/virologia , Teicoplanina/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: Empyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention. DESIGN/SETTING/PATIENTS: Retrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011-2018, admitted to a large Australian tertiary children's hospital. RESULTS: During the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1-5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05). CONCLUSION: We report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.
Assuntos
Empiema/etiologia , Pré-Escolar , Empiema/epidemiologia , Empiema/patologia , Empiema/terapia , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida , Terapia Trombolítica/métodos , Resultado do TratamentoRESUMO
INTRODUCTION: Cutibacterium acnes is a commensal bacterium of the skin, frequently reported in prosthetic shoulder or spinal implant infections, but rarely in cranial and intracranial infections. METHODS: We retrospectively reviewed patients with intracranial samples positive to Cutibacterium acnes managed in the neurosurgical units of our hospital of Lyon, France, between 2008-2016. RESULTS: We included 29 patients, of whom 23 had empyema (with or without abscess), 17 had cranial osteomyelitis, and six only had abscess. Prior neurosurgery was reported in 28 patients, and the remaining patient had four spontaneous abscesses. Twelve patients had polymicrobial infections, including methicillin-susceptible Staphylococcus in 11 cases. The clinical diagnosis was difficult because of indolent and delayed symptoms: a CT scan or MRI was required. Thirteen patients (52%) had material at the infection site. All patients with bone flap implant or bones from biological banks had a bone flap-associated infection. Drainage was surgically performed in 25 cases or by CT scan-guided aspiration in four cases. All patients received an adapted antibiotic therapy (from three weeks to six months). The outcome was favorable in 28 patients. Three patients relapsed during the antibiotic therapy, requiring further surgery. CONCLUSION: Cutibacterium acnes can be responsible for postoperative empyema and cerebral abscesses, with particular indolent forms, which make their diagnosis difficult. They are often polymicrobial and associated with bone flap osteomyelitis. Their outcome is favorable after drainage and adapted antibiotic therapy.
Assuntos
Abscesso Encefálico/microbiologia , Craniotomia/efeitos adversos , Empiema/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Propionibacteriaceae/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/terapia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Terapia Combinada , Diagnóstico Tardio , Drenagem , Resistência Microbiana a Medicamentos , Empiema/diagnóstico por imagem , Empiema/epidemiologia , Empiema/terapia , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Osteomielite/epidemiologia , Osteomielite/microbiologia , Propionibacteriaceae/efeitos dos fármacos , Propionibacteriaceae/patogenicidade , Estudos Retrospectivos , Pele/microbiologia , Crânio/microbiologia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/terapia , VirulênciaRESUMO
OBJECTIVES: Feline intracranial abscessation or empyema is infrequently reported in the veterinary literature. To date, the largest study is based on a population of 19 cats with otogenic infection. The aim of this study was to review a larger population of cats with intracranial empyema from multiple aetiologies and document their signalment, imaging findings, treatment protocols (including medical and/or surgical management) and to compare outcomes. METHODS: Cases presenting to a single referral centre over a 10 year period with compatible history, neurological signs and imaging findings consistent with intracranial abscessation and empyema were reviewed retrospectively. RESULTS: Twenty-three cats met the inclusion criteria. Advanced imaging (CT and/or MRI) was performed in 22/23 cats; one case was diagnosed via ultrasound. Ten cases underwent medical and surgical management combined, 10 underwent solely medical management and three were euthanased at the time of diagnosis. Short-term outcome showed that 90% of surgically managed and 80% of medically managed cats were alive at 48 h post-diagnosis. Long-term survival showed that surgically managed cases and medically managed cases had a median survival time of 730 days (range 1-3802 days) and 183 days (range 1-1216 days), respectively. No statistical significance in short- or long-term survival ( P >0.05) was found between medically and surgically managed groups. CONCLUSIONS AND RELEVANCE: Feline intracranial abscessation and empyema are uncommon conditions that have historically been treated with combined surgical and medical management. This study documents that, in some cases, intracranial abscessation and empyema can also be successfully treated with medical management alone.
Assuntos
Doenças do Gato , Infecções do Sistema Nervoso Central , Empiema , Animais , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/mortalidade , Doenças do Gato/terapia , Gatos , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Infecções do Sistema Nervoso Central/mortalidade , Infecções do Sistema Nervoso Central/terapia , Infecções do Sistema Nervoso Central/veterinária , Empiema/diagnóstico por imagem , Empiema/mortalidade , Empiema/terapia , Empiema/veterinária , Imageamento por Ressonância Magnética , Estudos RetrospectivosRESUMO
Intracranial empyema is a rare but serious complication of sinusitis in children. Myelodysplastic/myeloproliferative syndromes (MMS), including juvenile myelomonocytic leukemia (JMML), can lead to immunosuppression, thus favouring infections. We report the case of a sphenoid sinogenic retro-clival extradural empyema in a 14-year-old female patient associated with JMML. Treatment consisted in an endonasal transphenoidal drainage of the empyema associated with intravenous antibiotherapy. The patient was thereafter enrolled in chemotherapeutic treatment with Azacitidine. The disease progressed to blast phase, indicating bone marrow graft. This is the first reported case of an endocranial complication of bacterial sinusitis associated with MMS in a child.
Assuntos
Infecções Bacterianas/complicações , Empiema/etiologia , Abscesso Epidural/etiologia , Leucemia Mielomonocítica Juvenil/complicações , Sinusite/complicações , Adolescente , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Drenagem , Empiema/terapia , Abscesso Epidural/terapia , Feminino , Humanos , Seio EsfenoidalRESUMO
BACKGROUND: Chest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion. OBJECTIVE: To evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital. MATERIALS AND METHODS: This was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre. RESULTS: Three hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery. CONCLUSION: Our technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.
Assuntos
Tubos Torácicos , Drenagem/métodos , Empiema/terapia , Derrame Pleural/terapia , Pneumonia/terapia , Ultrassonografia de Intervenção , Adolescente , Criança , Pré-Escolar , Empiema/diagnóstico por imagem , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Lactente , Masculino , Derrame Pleural/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Reino UnidoRESUMO
Fracture of the first rib is rare because of the anatomic protection provided by surrounding structures. Osseous fatigue caused by repetitive motion and antagonistic muscular contraction is postulated to contribute to nontraumatic first rib fracture, which is most often described in adolescent athletes in sports that involve repetitive overhead motion of the arm. In this report, we describe a 49-year-old man with an occupation involving repetitive overhead motion at the shoulder who was found to have a nontraumatic first rib fracture. The condition resolved with treatment.
Assuntos
Empiema/complicações , Empiema/diagnóstico , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Dor de Ombro/etiologia , Empiema/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas das Costelas/terapiaAssuntos
Abscesso Encefálico/etiologia , Empiema/etiologia , Otorrinolaringopatias/complicações , Otorrinolaringopatias/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/terapia , Criança , Estudos de Coortes , Empiema/diagnóstico , Empiema/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Supuração , Adulto JovemRESUMO
Pyogenic ventriculitis is a rare but severe post-neurosurgical complication. The infection is often resistant to antibiotic treatment alone. Continuous intraventricular irrigation has been suggested but the technique is cumbersome, increases the risk for secondary infection, and is inadequate in removing adherent purulence. We used a novel neuroendoscopic approach assisted with a side-cutting aspiration device to treat four cases of post-neurosurgical pyogenic ventriculitis. Ventricular empyema was cleared in all patients and three of the four patients had favorable outcomes.
Assuntos
Ventriculite Cerebral/terapia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Idoso , Ventriculite Cerebral/etiologia , Empiema/etiologia , Empiema/terapia , Feminino , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Paracentese/instrumentação , Paracentese/métodos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
Bacterial ventriculitis is one of the most common and serious complications of shunt placement. Shunt infection has varied management and is difficult to treat neurosurgically. We report a case of intraventricular empyema due to shunt infection. Standard management was failed for this case and reaccumulation of pus in the both ventricles. Neuroendoscopic surgery with intraventricular lavage and aspiration using cannula nasogastric tube (NGT) through a single burr hole, has successfully decreased the accumulation of intraventricular empyema. After lavage and aspiration, antibiotic can be distributed effectively to the affected area. Follow up imaging and cerebrospinal fluid (CSF) culture shown a good result and shorter length of stay in the hospital. Neuroendoscopy appears effective and safe for the management of bacterial ventriculitis due to shunt infection in infant. The strategy described in this report might be useful to treat intraventricular empyema.
Assuntos
Ventriculite Cerebral/terapia , Empiema/terapia , Neuroendoscopia/métodos , Derivação Ventriculoperitoneal/métodos , Ventriculite Cerebral/etiologia , Empiema/etiologia , Humanos , Lactente , Tempo de Internação , Masculino , Irrigação Terapêutica/métodos , Resultado do TratamentoRESUMO
A 9-year-old girl from black ethnic origin presented with a history of fever, cough, loss of weight and right-sided chest wall pain for 2 weeks. Chest X-ray demonstrated an effusion, which was shown to be loculated on chest CT scan. She was not responding to medical treatment and at thoracotomy loculated pus was drained. Mycobacterium tuberculosis (TB) was cultured from the pus. TB is a rare cause of loculated empyema with an overlapping clinical and radiological picture with pyogenic infections.