admin

Ans d

ANtibiotics and drainage

60 years ago, The American Thoracic Society first described the evolution of empyema as a continuous process that subdivides into three stages.

Exudative stage -

initial bacterial infection causes an acute inflammatory response between the pulmonary parenchyma and visceral pleural.

This exudative fluid is usually free-flowing, resolves with appropriate antibiotic treatment, and does not warrant any invasive drainage.

Fibrinopurulent and Loculated stage II)  In the absence of appropriate treatment, the effusion can become complicated via deposition of fibrin clots and membranes resulting in isolated collections of fluid in the pleural space

.At this stage, bacteriology usually becomes positive, and the effusion warrants antimicrobials and drainage.

Chronic Organizational stage - if not drained, fibroblasts coalesce to form a thick pleural peel between the visceral and parietal pleura. This peel can ultimately encase the underlying lung parenchyma and can complicate the clinical course via inhibition of adequate gas exchange, trapped lung or chronic forms of empyema.