What is empyema?
Empyema is also called pyothorax or purulent pleuritis. It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space. Pus is a fluid that’s filled with immune cells, dead cells, and bacteria. Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
脓胸通常在肺炎后发生，后者是肺组织的感染。
脓胸可以在您有肺炎。许多不同类型的细菌可能引起肺炎，但最常见的两个是链球菌肺炎e和金黄色葡萄球菌。有时，脓肿可能会在您的胸部进行手术后发生。医疗仪器可以将细菌转移到胸膜腔中。
胸膜空间自然具有一定的液体，但是感染会导致液体比吸收的速度更快。然后，液体被引起肺炎或感染的细菌感染。感染的液体变稠。它可能导致肺部和胸腔的衬里粘在一起并形成口袋。这称为脓胸。您的肺可能无法完全膨胀，这可能会导致呼吸困难。
The biggest risk factor for empyema is having pneumonia. Empyema occurs most frequently in children and older adults. However, it’s fairly uncommon. In onestudy，它发生在不到1％的肺炎儿童中。
Having the following conditions can also increase your chances of empyema after pneumonia:
- 支气管扩张
- 慢性阻塞性肺疾病（COPD）
- rheumatoid arthritis
- 酗酒
- diabetes
- 免疫系统弱
- surgery or recent trauma
- lung abscess
Empyema can be simple or complex.
简单的脓肿
简单的脓肿occurs in the early stages of the illness. A person has this type if the pus is free-flowing. The symptoms of simple empyema include:
- 呼吸急促
- dry cough
- fever
- 出汗
- 胸痛when breathing that may be described as stabbing
- 头痛
- 混乱
- 食欲不振
复杂的脓胸
复杂的脓胸发生在疾病的后期。在复杂的脓胸中，炎症更为严重。疤痕组织可能形成并将胸腔分为较小的腔。这就是所谓的定位，更难治疗。
如果感染继续恶化，则可能导致在胸膜上形成厚的果皮，称为胸膜果皮。这种剥离可防止肺扩张。需要手术来修复它。
复杂肌膜中的其他症状包括：
- difficulty breathing
- decreased breath sounds
- 减肥
- 胸痛
In rare instances, a case of complex empyema can lead to more severe complications. These include败血症和a collapsed lung, also called a气胸。败血症的症状包括：
- 高烧
- chills
- rapid breathing
- fast heart rate
- low blood pressure
A collapsed lung can cause sudden, sharp chest pain and shortness of breath that gets worse when coughing or breathing.
These conditions can be fatal. If you have these symptoms, you should call 911 or have someone drive you to an emergency room.
医生可能会怀疑脓肿，如果您患有对治疗的反应的肺炎。您的医生将进行完整的病史和体格检查。他们可能会使用听诊器听取肺部任何异常的声音。您的医生通常会执行某些测试或程序以确认诊断：
- ChestX-rays和CT扫描will show whether or not there’s fluid in the pleural space.
- 胸部的超声波将显示流体及其确切位置。
- 血液测试可以帮助检查白细胞计数，寻找C反应蛋白，并确定引起感染的细菌。当您感染时，白细胞计数可以升高。
- 在thoracentesis, a needle is inserted through the back of your ribcage into the pleural space to take a sample of fluid. The fluid is then analyzed under a microscope to look for bacteria, protein, and other cells.
治疗旨在从胸膜中去除脓液和液体并治疗感染。抗生素用于治疗潜在的感染。抗生素的特定类型取决于哪种类型的细菌引起感染。
The method used to drain the pus depends on the stage of the empyema.
In simple cases, a needle can be inserted into the pleural space to drain the fluid. This is called percutaneousthoracentesis。
In the later stages, or complex empyema, a drainage tube must be used to drain the pus. This procedure is usually performed under anesthesia in an operating room. There are different types of surgery for this:
胸腔造口术：在此过程中，您的医生将在两个肋骨之间将塑料管插入胸部。然后，他们将管子连接到吸气设备并卸下流体。他们还可以注入药物以帮助排干液体。
Video-assisted thoracic surgery:您的外科医生将去除肺周围的受影响的组织，然后插入排水管或使用药物去除液体。他们将创建三个小切口，并在此过程中使用称为胸腔镜的微型相机。
Open decortication:In this surgery, your surgeon will peel away the pleural peel.