Thoracic empyema – A review based on three cases reports
Empiema torácico – Revisão baseada em três casos clínicos
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
2 Interno de Especialidade de Medicina Interna/Intern, Internal Medicine
3 Assistente Hospitalar Graduado de Pneumologia/Consultant, Pulmonology graduate
4 Assistente Hospitalar Graduada de Medicina Interna/Consultant, Internal Medicine graduate
5 Director de Serviço de Radiologia/Director, Radiology Unit
6 Assistente Hospitalar Graduada de Patologia Clínica/Unit Consultant, Clinical Pathology graduate
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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) fibrinopurulent; (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 pyogenes</span> 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>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">O derrame parapneumónico caracteriza-se pela necessidade de um processo invasivo para a sua resolução e o empiema pela presença de pus na cavidade pleural. Em ambos os casos, o diagnóstico por TAC e o tratamento precoces resultando em menores morbilidade e mortalidade. São indicação para um tratamento invasivo os derrames loculados, os que ocupam 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 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 abordagem terapêutica varia entra toracentese terapêutica, colocação de drenagem torácica com ou sem instilação 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 aguda ocorrida durante um voo de avião; uma doente com empiema e bacteriemia por <span class="elsevierStyleItalic">Streptococcus pneumoniae</span> conduzindo a diagnóstico até então desconhecido de infecção por VIH.</p>" ] ] "NotaPie" => array:4 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">Hospital Curry Cabral – Internal Medicine.</p>" ] 1 => array:2 [ "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara">Hospital Pulido Valente – Pneumology.</p>" ] 2 => array:2 [ "etiqueta" => "***" "nota" => "<p class="elsevierStyleNotepara">Hospital Curry Cabral – Radiology.</p>" ] 3 => array:2 [ "etiqueta" => "****" "nota" => "<p class="elsevierStyleNotepara">Hospital Curry Cabral – Pathology.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:46 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 3 | 11 |
| 2024 October | 46 | 40 | 86 |
| 2024 September | 45 | 41 | 86 |
| 2024 August | 45 | 48 | 93 |
| 2024 July | 39 | 41 | 80 |
| 2024 June | 37 | 40 | 77 |
| 2024 May | 37 | 41 | 78 |
| 2024 April | 28 | 29 | 57 |
| 2024 March | 22 | 28 | 50 |
| 2024 February | 34 | 31 | 65 |
| 2024 January | 22 | 24 | 46 |
| 2023 December | 24 | 27 | 51 |
| 2023 November | 18 | 29 | 47 |
| 2023 October | 23 | 57 | 80 |
| 2023 September | 32 | 43 | 75 |
| 2023 August | 22 | 28 | 50 |
| 2023 July | 22 | 39 | 61 |
| 2023 June | 15 | 30 | 45 |
| 2023 May | 18 | 46 | 64 |
| 2023 April | 15 | 18 | 33 |
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