What Could Cause Fluid In The Lungs – An empyema, also known as a pulmonary empyema, refers to the accumulation of infected fluid (ie, pus) in the pleural cavity (ie, the space between the lungs and the membrane that surrounds them). Most often, empyema is associated with bacterial infections, such as bacterial pneumonia, but it can also develop after surgery or trauma to the chest.

In general, an effusion is when fluid collects in a body cavity. For example, a pleural effusion is the accumulation of fluid of any consistency within the pleural space. A pleural effusion can be transudative (when fluid leaks into the pleural space, as is commonly seen in heart failure) or exudative (when inflammatory conditions, such as pneumonia, cause fluid to enter the pleural space). An example of an exudative effusion is a parapneumonic effusion, which occurs when fluid accumulates in the pleural space due to associated pneumonia. Empyema is a subset of pleural effusion and may be considered a parapneumonic effusion if caused by associated pneumonia.

What Could Cause Fluid In The Lungs

Empyema most often presents as a complication of pneumonia. In fact, at least 20% of patients with pneumonia will later develop a parapneumonic effusion that can lead to empyema. Empyema can also result from chest trauma or surgery, esophageal tears, or cervical infections. The causative organism may differ depending on whether the empyema is community-acquired or hospital-acquired (ie, infection acquired outside the healthcare setting and infection occurring more than 48 hours after hospital admission, respectively). Community-acquired empyema usually contains gram-positive bacteria, most commonly Streptococcus. Gram-negative bacteria can also be the underlying cause; However, they are usually found in individuals who have other comorbidities, such as diabetes, gastroesophageal reflux disease (GERD), and alcohol use disorder. On the other hand, hospital-acquired empyema can involve more resistant bacteria such as methicillin-resistant S. aureus (MRSA) as well as Pseudomonas. Finally, empyemas are commonly caused by S. aureus in individuals with post-surgery or trauma. Anaerobic organisms (eg, Bacteroides fragilis, Anaerobic cocci) are additional causes of postoperative empyema but can be difficult to diagnose because of variability in clinical presentation and negative fluid cultures. Fungal empyemas, primarily caused by Candida species, are rare, are primarily associated with immunocompromised individuals, and tend to have a higher mortality rate.

Pleural Cavity: Anatomy, Effusion Causes, Treatment

Signs and symptoms of empyema include fever. cough and pleuritic chest pain that worsens when the individual inhales, coughs, or sneezes. These symptoms usually last for about 15 days and do not improve even after taking appropriate antibiotic treatment. On physical examination, dullness of percussion over the affected area and abnormal sounds will be noted on auscultation, which may include decreased or absent breath sounds or subtle vibrations in the affected area.

Empyema is diagnosed after a thorough review of the individual’s medical history and physical examination. A healthcare provider may listen to the chest with a stethoscope to look for signs of pneumonia and fluid buildup. Additional diagnostic testing is often necessary because many conditions can present in the same way. Initially, chest X-rays are usually ordered to assess for any pleural effusions. This is characteristic on X-rays as obturation of the costodiaphragmatic angles, which means that the angle created by the diaphragm and rib disappears or has indistinct boundaries due to fluid accumulation.

If the X-ray is not indicative, an ultrasound examination can be performed at any time. Empyema may be suspected when the parietal and visceral pleura are thickened and separated by fluid that appears as a homogeneous anechoic mass on ultrasound.

A CT scan of the chest is also necessary for people with empyema, preferably with intravenous (IV) contrast. Both ultrasound and computed tomography are useful diagnostic tools with high sensitivity in detecting empyema. Similarly, the pleura can be thickened, separated, and contrast enhanced on CT. In addition, CT also offers better visualization of the lung parenchyma for other pathologies.

What Causes Empyema?

After all the necessary preliminary imaging, a thoracentesis (a minimally invasive procedure in which a needle is inserted into the pleural space to drain pus) is usually performed to drain the fluid and send it for analysis and culture. It is important to note that all pleural fluids should be processed and sent for further analysis. However, negative cultures do not rule out the diagnosis because some bacteria are more difficult to culture.

Treatment of empyema usually requires both medical and surgical treatment. The most important thing is to start antibiotics quickly to control the infection. Antibiotics are selected empirically, depending on whether the infection is community-acquired or hospital-acquired, and may be modified further based on assay and culture results. For community-acquired empyema, a third- or fourth-generation cephalosporin (eg, cefepime) is preferred. Metronidazole or ampicillin with a beta-lactamase inhibitor can be added to cover anaerobic organisms as well. Hospital-acquired, trauma-related, and surgical-related empyema can be treated with vancomycin, cefepime, and metronidazole or piperacillin-tazobactam. Antibiotics against anaerobic bacteria may be added to the treatment regimen because they are very difficult to isolate. Antibiotics are usually given for two to six weeks, depending on the individual’s infection and response to treatment. There is no proven benefit from intrapleural injection of antibiotics.

In addition, the accumulation of pus must be drained in order for the empyema to completely resolve. Tube thoracostomy refers to the placement of a chest tube into the pleural cavity and is the most common type of drainage. The position of the tube is confirmed by X-ray or CT scan. Chest tube blockage can be prevented by frequent saline flushes. If the fluid build-up continues, more drastic treatment options with larger tubes or even surgery should be initiated. Chest tubes are usually removed when the daily drainage volume falls below 50 to 100 mL/day for more than two consecutive days (assuming no obstruction in the tubes), reduction in pleural effusion is confirmed by imaging, and the individual is discharged; or no signs of infection.

The goal of surgical treatment is to remove pus from the pleural cavity and help the lungs to expand properly. In individuals requiring surgical intervention for acute empyema, video-assisted laparoscopic thoracotomy (VATS) is usually the treatment of choice. It is a minimally invasive procedure that results in very little blood loss, less pain, better respiratory outcomes, less hospitalization, and better survival outcomes. If serious complications cannot be controlled laparoscopically, the operation may be converted to an open chest (ie, a major surgical procedure requiring an incision into the pleural space).

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After the acute phase of infection, some individuals may develop fibrosis at the site of empyema and lung constriction, which may cause dyspnea. Decortication, which is a surgical procedure performed to remove abnormally formed fibrous tissue on the surface of the lungs, chest wall, or diaphragm, can help relieve these symptoms. This procedure may be considered when lung limitation and symptoms persist six months after the infection clears and affect the individual’s quality of life.

An empyema refers to the accumulation of infected fluid in a body cavity, especially the pleural space. It usually occurs as a result of bacterial infections and pneumonia, and after trauma or surgery to the chest area. Signs and symptoms include fever, cough, and pleuritic chest pain. Diagnosing an empyema usually requires a physical exam followed by imaging (eg, chest X-ray, ultrasound, and CT scan) and minimally invasive procedures such as thoracentesis. Treatment usually consists of antibiotics and incisions in the pleural space to remove the pus collection.

Bell, D. J. (2021, June 16). Blunting of the costophrenic angle. In Radiopedia. Retrieved February 3, 2022, from https://radiopaedia.org/articles/blunting-of-the-costophrenic-angleThoracentesis is a procedure in which a provider uses a needle to drain excess fluid from the lungs (pleural space). It is used to test the fluid for infection or other diseases and to relieve chest pressure that makes breathing difficult. Thoracentesis is a short, low-risk procedure that is performed while you are awake.

During a mastectomy, your provider will insert a needle between your ribs to drain fluid from your lungs (pleural space).

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Thoracentesis is a procedure that removes fluid from around the lungs (pleural space). The pleural space is the area outside your lungs but inside your chest wall.

Your lungs and chest wall are both lined with a thin layer called the pleura. A small amount of fluid between these two layers helps them slide past each other smoothly as your lungs expand and contract as you breathe. Just like a hinge needs oil to keep a door moving smoothly, your lungs need pleural fluid to breathe.

Some medical conditions and diseases cause fluid to leak into the pleural space (pleural effusion), making it difficult to breathe. Health care providers use thoracentesis to remove fluid for disease or symptom relief.

Thoracentesis and paracentesis both remove excess fluid from your body. Thoracentesis removes fluid from your chest, and paracentesis removes fluid from your abdomen.

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During the procedure, fluid is drained from the chest, which usually takes about 15 minutes. Chest tube or smaller drain

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