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Diseases of the Pleura II - Pleural Shock, Tuberculous Plueral Effusion and Empyema


The patient develops a vasomotor collapse on the pleural crest. Insufficient local anesthesia may be a factor in predisposition. Immediate resuscitation actions include adrenaline injections, parenteral steroids, and intravenous fluids. Pleural shock may be fatal, if not recognized in time.

Bleeding into the pleural cavity is from the conduit on the pleural surface. Bleeding should be suspected when the fluid inhaled becomes colored blood. In some cases, hypovolemic shock may occur. When bleeding is obvious, it is recommended to stop the procedure. Accidental air intake during aspiration converts simple pleural effusion into hydropenumothorax. Rare subcutaneous or air embolism may develop.

Pulmonary edema occurs in some cases of chronic extraction when the lungs develop by releasing fluid. Slow aspiration and restricting the amount of fluid inhaled by one to one liter helps in reducing this complication. The onset of pulmonary edema is caused by a troublesome cough with foam exploitation. Auscultation reveals the presence of rales. The onset of pulmonary edema is a clue to stopping aspiration. Further management is similar to acute pulmonary edema. The pleural drainage, which is part of the general edema, cleanses when the underlying condition is treated. Unless there is respiratory embarrassment, paracentesis is required for diagnostic purposes only.


Among the causes known for pleural effusion in Africa and the Asian subject, tuberculosis is still at the top of the list. Pleura may be directly affected by the tube process. In most cases it spreads from the underlying pulmonary focus and flows almost always next to the lung lesions. Occasionally a subpleural fissure may rupture into the pleural cavity or pleura may become the seat of the military lesion. In the majority of cases the classic juvenile effusions are a phenomenon of postprimary tuberculosis although rare in primary tuberculosis. The flow can grow rapidly or insidiously. Most cases reveal a positive tuberculosis test. Fluids are exudate. Cells are mainly lymphocytes. Tubercula bacilli are difficult to detect in serous effusions. Culture and animal inoculation may be positive. In tuberculosis empyema, the organism is most easily proven. Needle biopsy is very helpful, but this is not required in the normal case.

Management: Standard antituberculosis treatment begins. The pleural aspiration is performed electively. Repeated aspiration may be necessary to make the pleural cavity dry. Respiratory physiotherapy is essential for immediate recovery. The use of corticosteroids (Prednisolone 15-20 mg / day) helps accelerate recovery and prevent pleural thickening.


The accumulation of pus in the pleural cavity is called empyema. The nail can be released in the pleural space or framed. Empyema may be caused by a contagious infection of the underlying lung, or it may complicate chest injury, hemorrhage, or general pyemia. Pneumonia, lung abscess, bronchiectasis, recurrent voids, hepatopulmonary amoebiasis, bronchogenic carcinoma, rib osteomyelitis, fungal infections and actinomycosis are common causes. Thoracic and upper abdominal surgery can cause empyema. Common bacterial flora include streptococcus, staphylococcus, Pneumococcus, Pseudomonas, Klebsiella, H.influenzae, anaerobes, M. tuberculosis, and actinomycetes.

Clinical features: All ages may be affected, but children suffer more. The attack is characterized by high fever, pleuritis or dull chest pain and dry cough. The physical signs of pleural effusion may be evident. Unlike simple pleural effusion, the chest wall becomes edematous (bronco-pleural fistula). In this case, postural cough is a troublesome symptom and its discovery is pyopneumothorax. Grandma can walk outside and point to the chest wall. This is called the need for empyema. Left-sided empyema may be pulsating due to pulsations transmitted from the heart - "pulmonary empyema".

Radiologically, these findings resemble those of the pleural effusion. Demonstration of pus in the pleural cavity by aspiration confirms the diagnosis. The causative organisms can be identified by pus examination. Clinically, large lung abscess may resemble empyema or encysted pyopneumothorax and these two conditions need to be distinguished. Fever, toxin and digital clubbing are common. The shift of the mediastinum in the opposite direction and the foolishness of the rock in the percussion are in favor of empyema. Special radiological techniques may be needed to distinguish them. In the pyopneumothorax found, fluid airway obstruction can violate the anatomy of the lobe, while lung abscesses are limited by interlobar gaps.

Complications of empyema include severe toxemia, cachexia, anemia, pulmonary fibrosis, pleural fibrosis, metastatic brain abscess and in older cases, secondary amyloidosis. Overall mortality was 10-11%.

Treatment: After determining the infecting organism, antimicrobial treatment is started. These fluids need to be released by aspiration and these measures are important for eliminating fever and toxicity. When the pus is too thick to inhale. or if it recovers quickly, under drainage should be established after rib resection. Cleansing of the pleural space and enlarging the lungs may take several weeks to complete. Although antibiotics used to be implanted locally into pleural cavities with adequate systemic chemotherapy, this measure is not important. Thick, hard-pressed dragons can be diluted by proteolytic enzyme stabilizers such as streptokinase and streptodornase. In most cases, chemotherapy and surgical drainage are sufficient to clean the empyema. Acute hemorrhagic infections may need to be removed through surgery.


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