Chronic suppurative pleurisy

Overview of acute empyema 4 ~ 6 weeks of treatment Vomica not disappear, Pott flushing and a large sediment, suggest empyema has entered chronic phase. Cause pathogenesis of chronic empyema is mainly due to : (1) acute treatment of empyema in a timely manner is not appropriate. (2) after surgery if bronchopleural fistula or esophageal fistula. (3) adjacent to a pleural lesions chronic infection, such as subphrenic abscess, liver abscess, mediastinal abscess and osteomyelitis ribs and other source of infection has not been completely eliminated, the chronic empyema. (4) the chest with foreign bodies : If trauma, metal, bone slices, clothing and other debris retained foreign body in the chest caused secondary infection. (5) tuberculous empyema. Clinical manifestations of chronic empyema patients as a result of long-term infection, physical exertion, pleural thickening height, Special appearance of pleural thickening is particularly notable. Enophthalmos chest wall, rib gather together, intercostal space narrowing, spine bent towards the opposite side, the patient restrictive respiratory dysfunction, Some patients have clubbed fingers. Chronic empyema penetrating intercostal space with the dumbbell-shaped chest wall abscess formation, dressed as empyema, most of tuberculous empyema timely treatment complications. Chronic empyema patients, there will be hypoproteinemia and low hemoglobin disease, and liver and kidney dysfunction. Patients often have weight loss, anemia, reduced plasma protein, and different degrees of chronic systemic poisoning symptoms, such as fever, weakness, poor appetite. Screening chest X-ray shows no significant pleural thickening, intercostal space narrowing, the ipsilateral mediastinal shift, chest smaller. If suspected bronchiectasis when bronchial angiography should be OK. Chronic empyema done without drainage, to be done pleural puncture, Wound cultures, in a clear empyema pathogenic strains. As the use of antibiotics, the culture may be negative. For bronchopleural fistula, to Intrapleural Meilan be available in the near future appeared to be expectorated in the sputum. Blood tests, and leukocytosis. Treatment of chronic empyema the treatment is to remove the cause of the disease, closed Vomica. The vast majority of patients will need surgery and antibiotics (Cefetaxime acridine, cefazolin V, ofloxacin, metronidazole). In the course of treatment, we must take care of the body, to encourage patients to more activities and to strengthen the cardiovascular system. Nutritional supplement, plasma proteins, to correct anemia, before a larger operation. (1) Improve drainage : Some patients with the drainage improvements were cured. (2) pleural fibreboard endarterectomy : Timing of surgery is essential. The application of lung surgery without significant changes, pleural thickening chronic empyema, early for the best effect. (3) within the pleural thoracic changing of : This method applies to pleural thickening in more serious cases. (4) Extrapleural thoracic changing of : applicable to pleural thickening is not too serious and has lung disease cases. (5) pleural pneumonectomy : as chronic empyema combined with the widespread and serious lung disease, Other surgical methods can not cure, for the purposes of pleural pneumonectomy or pleural lobectomy indications.