Lung abscess predicts the surgical outcome in patients with pleural empyema

Abstract

ObjectivesMost cases of pleural empyema are caused by pulmonary infections, which are usually combined with pneumonia or lung abscess. The mortality of patients with pleural empyema remains high (up to 20%). It also contributes to higher hospital costs and longer hospital stays. We studied pleural empyema with combined lung abscess to determine if abscess was associated with mortality.MethodsFrom January 2004 to December 2006, we retrospectively reviewed 259 patients diagnosed with pleural empyema who received thoracscopic decortications of the pleura in a single medical center. We evaluated their clinical data and analyzed their chest computed tomography scans. Outcomes of pleural empyema were compared between groups with and without lung abscess.ResultsTwenty-two pleural empyema patients had lung abscesses. Clinical data showed significantly higher incidences in the lung abscess group of pre-operative leukocytosis, need for an intensive care unit stay and mortality.ConclusionPatients with pleural empyema and lung abscess have higher intensive care unit admission rate, higher mortality during 30 days and overall mortality than patients with pleural empyema. The odds ratio of lung abscess is 4.685. Physician shall pay more attention on high risk patient of lung abscess for early detection and management.

The value of chest magnetic resonance imaging compared to chest radiographs with and without additional lung ultrasound in children with complicated pneumonia

“…The abscess wall typically appears hypointense compared to the fluid-isointense center of the abscess formation and can be clearly identified on T2-weighted images. In the clinical context the diagnosis of lung abscess formation is important, since it seems to be associated with a higher admission rate to the intensive care unit, while also bearing the risk of bronchopleural fistulas that typically require surgical intervention [35][36][37]. Besides detection it is also important to reliably evaluate treatment response in conservative therapy.…”

The time course of resolution of adhesions during fibrinolytic therapy in tetracycline-induced pleural injury in rabbits

“…Thus IPFT represents a less invasive and costly alternative to video-assisted thoracic surgery or other surgical interventions, which demonstrate comparable efficacy (16,44,45,58,60,71) in pediatric practice. IPFT also represents a preferred choice in high-risk (1,22) and otherwise inoperable patients (10,43,49,56,57,69) or those with empyema/ loculation who refuse surgery. The reasons for the inconsistent results of IPFT in adult patients remain unclear but likely reflect the empiric approaches that are currently used.…”

Treatment of pediatric parapneumonic empyemas with pulmonary cavitary lesions

“…Surgery is recommended for lung abscesses in the presence of complications such as BPF and pleural empyema. [6] Pneumonia is a common childhood disease, with an incidence of 1.0 to 4.5 per 100 children annually, and it generally responds well to antibiotic treatment. [1] Nevertheless, complications due to the development of pleural effusion can develop that may progress to empyema.…”