Empyema of the pleura

Specific empyema of the pleura is caused by a tubercle bacillus, nonspecific forms have streptococcal, staphylococcal and
Mixed nature. Empyema of the pleura may develop due to penetrating
Injuries in the chest or with the spread of a purulent process from the chest and
Lung.

The main causes of the disease are caverns and cysts in the lung,
Tumors, abscesses, pneumonia, osteomyelitis of the ribs. Much less often purulent pleurisy
Occurs as a result of acute appendicitis, sepsis, and angina. As a result,
Tuberculosis of the lungs there is a tuberculous pleurisy.

Acute pleural empyema is a severe complication of intrathoracic operations, mainly on the esophagus and lungs. The acute pleurisy lasts 2-3 months. Symptoms of empyema are fever, side pain, dyspnea. The limitation of the mobility of the chest during the respiratory process is found.

Removal of purulent accumulations from the pleural cavity, as a rule, leads to spreading of the lungs and improves the patient's condition. The picture of blood and the temperature are normalized, recovery comes. In case of untimely and insufficiently active therapy, acute pleural empyema can go into a chronic form. In such patients, the thorax becomes flat and sagging, the intercostal space narrows, the motor activity decreases, and scoliosis develops over time. With long-term long-term treatment, cardiac and pulmonary insufficiency, exhaustion, amyloidosis of organs can occur.

The disease is diagnosed by electrocardiography, puncture, spirography, radionuclide methods. Based on the analysis of the findings, a diagnosis is made-empyema of the pleura. Treatment is performed by an aspiration method,
That is, with the evacuation of purulent accumulations from the pleural cavity. With insufficient
The effectiveness of this method pleural empyema is treated surgically. Important
The antibacterial, detoxifying and
General restorative therapy. Patients are advised to take antibiotics, respiratory gymnastics, infusion therapy and vitamin-rich foods.

The pleural empyema is usually eliminated as a result of aspiration therapy. Fistulas heal, the lung is gradually straightened. Surgery is performed in situations where it is not possible to spread the lung with conservative methods. The operation is also performed with the development of an abscess or cavity in a collapsed lung, with a chronic course of the disease.

Empyema of the pleura is also treated with intercostal thoracotomy with careful removal of fibrin and pus, multiple washing of the cavity with antiseptic solutions with proteolytic enzymes. Two drainages are introduced into the cavity, followed by a closure. In this case, solutions of antiseptics or antibiotics are poured through the first drainage, and the contents of the pleural cavity are regularly aspirated through the second.

Treatment of a chronic form of purulent pleurisy is achieved only through surgical intervention. The most effective is the complete removal of the empyema sac, the so-called pleurectomy with decortication
Lung. This method improves the function of breathing and leads to the spreading of the lungs.
The operation in this case is not accompanied by severe deformations of the thorax.
In many cases, the operation to remove the pleura sac is combined with different
Variants of a resection of a lung. Sometimes such interference is contraindicated because of
Severe respiratory distress, general poor patient condition, small
Chances of pulmonary airflow due to pneumofibrosis. In such cases, stepwise thoracoplasty is used.