Course of the disease with a pleural empyema
A pleural empyema is usually preceded by an infectious disease, which can enter the body in various ways. Only when this inflammation reaches the edges of the lungs and the pleura can pus accumulate there. The original inflammation may be highly acute and active, or it may have already healed to a large extent, or it may have encapsulated itself as an abscess.
For this reason, the course, duration and prognosis of a pleural empyema vary greatly. With the intake of antibiotics, the empyema usually improves within 2-3 weeks. The empyema can partially resorb itself.
However, in almost all cases of infectious effusion, a drainage is inserted into the chest cavity to immediately suck out the pus. The amount of pus removed slowly decreases during the course of therapy until there is no longer any effusion. What can be expected when pus is present in the lungs? The course and possible complications can be seen in the following article: What happens in the presence of pus in the lungs?
Duration of a pleural empyema
The pleural empyema only develops if there is still an active inflammation in the surrounding tissue. In most cases this is an acute pneumonia. The duration of the disease can vary greatly and depends on many factors.
The correct therapy as well as the response of the immune system are crucial. A harmless pneumonia usually subsides within 2-3 weeks. The pus formation in the pleura should also subside within this period. In severe cases of non-response to therapy, the healing process can be delayed indefinitely.
Treatment of a pleural empyema
The treatment focuses on the therapy of the underlying disease.If there is an inflammation in the breast area, it must be treated as quickly as possible with antibiotics, surgery or other measures before it can spread to surrounding organs. In most cases, the pleural empyema is also treated with antibiotics. In addition, a tube is usually placed between the pleural leaves to aspirate the empyema.
This tube remains in the thorax as a drainage in order to be able to suck out further pus until the inflammation has subsided. Smaller effusions resorb themselves. Surgical treatment of the inflammation is rarely necessary.
The installation of a drainage between the pleural leaves is only a slightly invasive therapeutic intervention. Only in rare forms of peuraempyema does an actual surgical opening of the thorax become necessary. This is necessary in cases of encapsulated inflammation and special locations of the pleural empyema.
For this purpose, a small window of the ribs can be made above the site of inflammation to clear out the inflammation, irrigate and insert a drainage. In the case of severe and long-lasting pleural empyema, the pleural leaf can also be removed or a sponge containing antibiotics inserted. In most cases of a pleural empyema, puncture is performed both diagnostically and therapeutically.
Diagnostically, the puncture is the most common method to reliably detect an accumulation of pus and to examine the sample in the laboratory for the exact pathogens. Also therapeutically, in most cases a puncture of the pleura is necessary to drain the pus and insert a drainage to drain future pus. The puncture is usually performed under local anesthesia and sterile to prevent further pathogens from entering the thorax. In everyday clinical practice, a thoracentesis is not uncommon and promises, with a low risk, a detailed diagnosis of the underlying disease and relief of the lungs. Everything important on the topic of “Pleural Puncture” is explained in the following: How is a pleural puncture performed?
