Empyema is a collection of pus in the pleural cavity that usually arises due to a pre-existing lung infection spreading into the pleural space. As pus and inflammatory exudate build up in the pleural cavity, fibrous tissue forms which contracts and restricts lung expansion. Treatment aims to remove infection, fully expand the lungs, and prevent rigid chest wall formation through methods like drainage, irrigation with antibiotics, and potentially decortication surgery to peel thickened pleura off the lungs. Physiotherapy focuses on minimizing adhesions, regaining full lung expansion, clearing lungs, and improving exercise tolerance through breathing exercises and postural drainage.
Empyema is a collection of pus in the pleural cavity that usually arises due to a pre-existing lung infection spreading into the pleural space. As pus and inflammatory exudate build up in the pleural cavity, fibrous tissue forms which contracts and restricts lung expansion. Treatment aims to remove infection, fully expand the lungs, and prevent rigid chest wall formation through methods like drainage, irrigation with antibiotics, and potentially decortication surgery to peel thickened pleura off the lungs. Physiotherapy focuses on minimizing adhesions, regaining full lung expansion, clearing lungs, and improving exercise tolerance through breathing exercises and postural drainage.
Empyema is a collection of pus in the pleural cavity that usually arises due to a pre-existing lung infection spreading into the pleural space. As pus and inflammatory exudate build up in the pleural cavity, fibrous tissue forms which contracts and restricts lung expansion. Treatment aims to remove infection, fully expand the lungs, and prevent rigid chest wall formation through methods like drainage, irrigation with antibiotics, and potentially decortication surgery to peel thickened pleura off the lungs. Physiotherapy focuses on minimizing adhesions, regaining full lung expansion, clearing lungs, and improving exercise tolerance through breathing exercises and postural drainage.
Empyema is a collection of pus in the pleural cavity that usually arises due to a pre-existing lung infection spreading into the pleural space. As pus and inflammatory exudate build up in the pleural cavity, fibrous tissue forms which contracts and restricts lung expansion. Treatment aims to remove infection, fully expand the lungs, and prevent rigid chest wall formation through methods like drainage, irrigation with antibiotics, and potentially decortication surgery to peel thickened pleura off the lungs. Physiotherapy focuses on minimizing adhesions, regaining full lung expansion, clearing lungs, and improving exercise tolerance through breathing exercises and postural drainage.
Empyema is a collection of pus in the pleural cavity.
ETIOLOGY
• The condition of empyema usually arises secondary to
pre-existing lung disease, such as bacterial pneumonia, tuberculosis, lung abscess, or bronchiectasis. • The most common cause is direct spread of infection into the pleural space in a patient with pneumonia due to Strep.Pneumoniae. • It may also arise as a result of a stab wound or as a complication of thoracic surgery. PATHOLOGICAL CHANGES
• Infected material enters the pleural cavity. Both layers of
pleura become covered in thick inflammatory exudate within which fibrous tissue is laid down. • As this fibrous tissue contracts it acts as a physical barrier to lung expansion. The pressure of the fibrous tissue on the pus may cause rupture of the pleura and lung tissue and the pus may then be coughed up. Alternatively, an abscess may form. • Healing occurs when the pus has been surgically removed or the infection has been overcome by the patient's natural antibodies, assisted by antibiotics. • The layers of the pleura come together and adhesion formation may take place, restricting lung movement. CLINICAL FEATURES
These include: • Pyrexia • Lassitude and loss of weight • Tachycardia • Dyspnoea • Pleuritic pain severe at first then decreasing in severity • diminished thoracic movements. There may be a history of pneumonia or other associated condition. INVESTIGATIONS
• On X-ray the empyema can be seen as a D-shaped
shadow, the straight line of the D being on the lung surface. • Pleural aspiration or tap will confirm the diagnosis as the sample is often thick and purulent, and may be foul- smelling. • Pleural fluid cytology will reveal an exudate with pus cells and organisms. PROGNOSIS
The prognosis depends on the cause, but untreated
infection can make the patient very ill from toxins absorbed into the bloodstream (toxaemia). TREATMENT The aims of treatment are to abolish infection; obtain full lung expansion, and prevent development of a rigid chest wall. Methods 1.Daily pleural aspiration, instillation of antibiotic, physiotherapy. This is very successful in infants and children. 2.Intercostal tube drainage and irrigation with antiseptic solution. 4. Rib resection and open drainage. 5. Thoracotomy and decortication. This is reserved for chronic empyemas of many months duration. The principle is to peel the thickened fibrotic layer of visceral pleura (cortex) off the surface of the lung. This allows the lung to expand fully and adhere to the parietal pleura. MEDICAL MANAGEMENT
Antibiotics are given to combat infection. Aspiration
through a needle inserted into the cavity may remove sufficient pus to relieve the condition, but continuous underwater drainage may be necessary. SURGICAL MANAGEMENT
• Rib resection may be indicated if the effusion is very
thick or loculated. • If the condition results in fibrosis of the pleura which severely limits lung expansion, then a rib resection may be performed and the pleura stripped off the lung (decortication). PHYSIOTHERAPY MANAGEMENT
The aims are:
• To minimise adhesion formation within the pleura • To regain full lung expansion • To clear the lung fields • To maintain good posture and thoracic mobility • To improve exercise tolerance. • If the patient has a chest drainage tube inserted, the physiotherapy is similar to that following a thoracotomy. Good posture should be encouraged whenever physiotherapy is being given. The tendency is for the patient to protect the affected side, by side-flexing to that side. Therefore, the patient should be taught to take weight evenly on both buttocks, to keep the shoulders level and to practice stretching to the opposite side from the lesion as well as stretching backwards. • Breathing exercises to expand the lung on the affected side need to be carried out three or four times daily. Postural drainage may be indicated to clear the lungs if secretions are accumulating. • As the patient recovers, general leg, arm and trunk exercises should be taught. Walking should begin as soon as possible with breathing control practised over progressively longer distances, and going down (then up) stairs incorporated. As the patient regains lung expansion, the treatment programme should be expanded to increase exercise tolerance.
