Artigo de Revisão/Review Article
Empiema torácico – Revisão baseada em três casos clínicos
Thoracic empyema – A review based on three cases reports
Antonio Murinello1, A. Manuel Figeiredo2, Júlio Semedo3, Helena Damásio4, N. Carrilho Ribeiro5, Helena Peres6
1 Chefe de Serviço Graduado de Medicina Interna/Unit Head, Internal Medicine graduate, Hospital Curry Cabral – Internal Medicine
2 Interno de Especialidade de Medicina Interna/Intern, Internal Medicine, Hospital Curry Cabral – Internal Medicine
3 Assistente Hospitalar Graduado de Pneumologia/Consultant, Pulmonology graduate, Hospital Pulido Valente – Pneumology
4 Assistente Hospitalar Graduada de Medicina Interna/Consultant, Internal Medicine graduate, Hospital Curry Cabral – Internal Medicine
5 Director de Serviço de Radiologia/Director, Radiology Unit, Hospital Curry Cabral – Radiology
6 Assistente Hospitalar Graduada de Patologia Clínica/Unit Consultant, Clinical Pathology graduate, Hospital Curry Cabral – Pathology
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Manuel Figeiredo, Júlio Semedo, Helena Damásio, N. Carrilho Ribeiro, Helena Peres" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Antonio" "apellidos" => "Murinello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Manuel Figeiredo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Júlio" "apellidos" => "Semedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] 3 => array:3 [ "nombre" => "Helena" "apellidos" => "Damásio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "af0020" ] ] ] 4 => array:3 [ "nombre" => "N." 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Em ambos os casos, o diagnóstico por TAC e o tratamento precoces resultando em menores morbi-lidade e mortalidade. São indicação para um tratamento invasivo os derrames loculados, os que ocu-pam mais de 50% do tórax, os que revelam coloração por Gram e exame cultural positivos, ou derrames com pH inferior a 7,20, glucose inferior a 60<span class="elsevierStyleHsp" style=""></span>mg/dl, e nível de DHL superior a três vezes o limite normal no soro. Estas características resultam da evolução através de três estádios dos derrames incorrectamente tratados: 1) exsudativo; 2) fibrino-purulento; 3) fibrótico. Dependendo do estádio evolutivo, a aborda-gem terapêutica varia entra toracentese terapêutica, colocação de drenagem torácica com ou sem instila-ção de fibrinolíticos, cirurgia toracoscópica vídeo-assistida e decorticação pulmonar. Os autores fazem uma revisão do estudo destas situações baseados em três casos clínicos com apresentações muito díspares: uma doente com empiema por <span class="elsevierStyleItalic">Streptococcus pyogenes</span> que faleceu rapidamente por hemoptise maciça; um doente com empiema resultante de pneumonia agu-da ocorrida durante um voo de avião; uma doente com empiema e bacteriemia por <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> conduzindo a diagnóstico até então desco-nhecido de infecção por VIH.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (3): 507-519</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Complicated parapneumonic effusion is one in which an invasive procedure is necessary for its resolution and empyema means pus in the pleural space. An early diagnosis and therapy of these conditions results in less morbidity and mortality. CT of the chest is important to study complex pleural effusions. Loculated effusions, those occupying more than 50% of the thorax, or which show positive Gram stain or bacterial culture, or a purulent effusion with a pH below 7.20, with a glucose level below 60<span class="elsevierStyleHsp" style=""></span>mg/dl or a LDH level more than three times the upper limit of normal for serum, are indications for an invasive procedure. These characteristics result from the evolution of a not well treated parapneumonic effusion, through the three stages: (1) exsudative; (2) fibri-nopurulent; (3) fibrotic. Depending on the stage therapeutic methods vary from therapeutic thoracentesis, insertion of a chest tube with or without instillation of fibrinolytics, video-assisted thoracoscopic surgery, and lung decortication. A review of all these aspects are done based on a series of three cases reports with very different clinical presentation: one patient with empyema by <span class="elsevierStyleItalic">Streptococcus</span> pyogenes and that died rapidly due to massive hemoptysis; a patient with empyema due to acute pneumonia developing during an airflight; a patient with empyema and bacteraemia by <span class="elsevierStyleItalic">Streptococcus pneumonia</span> leading to the diagnosis of an unknown HIV infection.</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009; XV (3): 507-519</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:46 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Article information
ISSN: 08732159Original language: Portuguese
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