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Empyema from Misplacement of Percutaneous Nephrostomy Tube—A Diagnostic Challenge
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Raed Abdulkareem, Francis J. Podbielski
Other studies have shown even lower yields of bacteria when pleural fluid is cultured. Jimenez et al., in a series 259 patients with a parapneumonic effusion, found that the pleural fluid culture revealed bacterial pathogens in only 50 (19.3%) of the cases [6]. Similarly, Po and colleagues demonstrated that a bacterial cause for the parapneumonic effusion was not found in 66 out of 91 cases [7]. Also, Wait et al. showed that 8 out of 20 loculated pleural effusions were negative for bacterial growth [8]. Thus, although one would expect to identify a bacterial etiology for an empyema, multiple sources show that a bacterial source is often elusive.
Necrotizing pneumonia
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
A simple parapneumonic effusion is fluid within the pleural cavity without loculations. Fibrin deposition in the pleural space can lead to a loculated parapneumonic effusion and is best visualized on ultrasound or CT. Empyema is a purulent parapneumonic fluid collection. Lung entrapment with pleural rind formation is seen with an organized multiloculated empyema. Necrotizing pneumonia is usually a result of localized infection and is associated with aspiration. Lung abscess can be the result of aspiration of foreign body or heavily infected oral secretions.
Respiratory infections
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
Clinically, patients present with a constellation of symptoms and signs that include fever, chills, cough with purulent sputum production, dyspnea, chest discomfort, tachycardia, and tachypnea with or without alterations in overall general condition depending on the severity of illness. Abnormal findings on physical examination include crepitation on auscultation (crackles) and signs of pulmonary consolidation such as dullness on percussion and bronchial breathing. Biologically, the majority of patients have leukocytosis as well as other nonspecific findings indicative of an inflammatory reaction such as an elevated C-reactive protein and sedimentation rate. The presence of a pulmonary alveolar-type infiltrate with an air bronchogram on a chest radiograph represents the gold standard for the diagnosis of pneumonia. Other possible radiographic patterns include segmental, lobar or multilobar distribution, and, on occasion, presence of an interstitial process. In approximately 20%–40% of cases, a pleural effusion called a parapneumonic effusion will be associated to the pneumonia [1,2,21].
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
Whilst CT may not be recommended as a routine part of evaluation of all patients with pleural effusion, it is crucial in the evaluation of malignant pleural effusion and pleural infection. CT can be used to distinguish simple versus complicated parapneumonic effusions[29]. The ‘split pleura’ sign – visceral and parietal pleural thickening with separation – is traditionally seen as diagnostic of empyema but may only be seen in 68% of patients[30]. In a retrospective study of patients in the ‘MIST’ trial, parietal pleural thickening and enhancement were noted in 98.7% of patients with pleural infection[31]. Complicated effusions may appear as lentiform homogenous fluid, rather than obeying gravity if they are free flowing[32]. CT may also be used to determine drain placement and plan for future surgery in the case of later stage empyema or complicated parapneumonic effusion.
Diagnostic accuracy of the cancer ratio for the prediction of malignant pleural effusion: evidence from a validation study and meta-analysis
Published in Annals of Medicine, 2021
Ying Zhang, Xiaoou Li, Junhui Liu, Xueru Hu, Chun Wan, Rui Zhang, Yongchun Shen
In this study, MPE was diagnosed based on the presence of malignant cells in pleural effusion or pleural biopsy specimens [2–3]. In patients with BPE, tuberculous pleural effusion was diagnosed if acid-fast bacteria could be cultured from pleural fluid or sputum, or if granulomas were present in pleural biopsy specimens, or if patients responded well to anti-tuberculosis therapy during follow-up of at least 3 months. Parapneumonic effusion was defined as any effusion associated with bacterial pneumonia, lung abscesses, or bronchiectasis. Two clinicians (YZ and XL) independently evaluated the association between pleural effusion and other comorbidities, such as acute pancreatitis, based on medical history, physical examinations, computed tomography, and patients’ response to treatment.
Incidence of parapneumonic empyema and complex parapneumonic effusion: A retrospective cohort study of 1766 pneumonia cases at a tertiary-level regional thoracic surgery referral center
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Anna L. McGuire, Dorsa Mousadoust, Ching Yeung, Renelle Myers, Kyle Grant, Basil Nasir, John Yee
As per American Thoracic Society (ATS) Guidelines, on a clinical level pneumonia is classified as community acquired (CAP), or hospital acquired (HAP). If pneumonia develops 48 hours or more following hospital admission, the classification is that of HAP.1 Approximately 20%–40% of all comers with pneumonia are reported to develop a parapneumonic effusion; with about 60% of these pleural effusions being directly related to a parapneumonic process, while the remaining 40% may be secondary to an indirect process such as systemic sepsis.2,3 Regardless, if best practice clinical management measures cannot contain the inflammatory infectious process, parapneumonic effusions evolve in complexity and develop into parapneumonic empyema.2 The clinical diagnosis of definite empyema is commonly reported as the presence of bacteria or frank pus in the pleural space.1 A complex parapneumonic effusion requires an invasive procedure, such as tube thoracostomy, for its resolution; or a parapneumonic effusion on which the bacterial cultures are positive.1