Background: Empyema is not rare in Vietnam and in the world. Objective: To study clinical, subclinical manifestations and lung CT-scan images of patients with empyema. Subjects and method: A study included 50 patients of empyema treated in Department of Respiratory of Bach Mai Hospital, from January 2003 to August 2005. This was a retrospective, prospective, descriptive, cross-sectional, controlled study. Results and conclusions: Most empyema commonly occurred in the setting of bacterial pneumonia. Empyema was common in males and the male-to-female ratio was 2.82. The onset of empyema was suddenly with clearly infection syndrome (high fever, increased WBC count, accelerated erythrocyte sedimentation rate), chest pain, and cough. CT images of empyema were ipsilateral; almost empyema was free pleural effusion and moderate in size. Thickening pleura was 72% and located pleura were 42%. Positive culture of pleural fluid was very low (24%). Gram (-) bacteria was predominant (P. Aeruginosa 33.3%, K. Pneumoniae 25%).
Empyema ; Pleural/diagnosis ; radiography

Subdural empyema is a neurosurgical emergency the mortality of which continues to be as high as 40% in modern reported series. It is also a curable lesion, and the outcome of treatment has been demonstrated to be directly related to the promptness of diagnosis and appropriate surgical drainage. Recently, we have operated upon two cases of intracranial subdural empyema secondary to acute facial furuncle and postoperative craniectomy. Reviewing these two cases and other literatures, we are going to describe about cases, symptoms and signs, and methods of diagnosis and treatment of subdural empyema.
Diagnosis ; Drainage ; Emergencies ; Empyema, Subdural* ; Furunculosis ; Mortality

BACKGROUND: The purpose decortication is to eliminate the infection focus and to improve the decreased lung function due to chronic empyema. However, lung function is not improved in all cases. It would be clinically useful it we could predict preoperatively whether lung function would improve after decortication. The purpose of this study is to find useful indices for predicting the possible improvement of lung function after decortication. METHOD: The medical records of 37 tuberculous empyema patients who underwent pleural decortication were analyzed retrospectively from 1990 to 1996. The measurements of preoperative and postoperative forced vital capacity(FVC) were used for evaluating the effects of decortication. RESULTS: The sex ratio was 29 : 8 (male to female), and the median age was 34 years. The time interval between the formation of empyema and operation was 1 month to 30 years. Postoperative pulmonary function test was performed 5.4±2.6 months later. FVC(forced vital capacity) was significantly increased from 2.77±0.67(L) to 2.95± 0.81(L). Interestingly, postoperative pulmonary function was significantly improved in patients who were less than 40 years old, within 4 months after diagnosis of tuberculous empyema, in the group with FVC of less than 60% of the predicted value and in the absence of calcification. CONCLUSION: The improvement of lung function after decortication was expected in patients younger than 40 years old, within 4 months after diagnosis of tuberculous empyema, in the group having less than 60% of the predicted FVC, without calcification.
Diagnosis ; Empyema ; Empyema, Tuberculous* ; Humans ; Lung ; Medical Records ; Respiratory Function Tests ; Retrospective Studies ; Sex Ratio

PURPOSE: To describe radiologic differences between tuberculous pleural effusion and empyema on the basis of computed tomography(CT). MATERIALS AND METHODS: We reviewed retrosepectively CT findings of 50 patients with pathologically and grossly proved empyema. Twenty-two patients had empyema, and 28 patients had tuberculous pleurisy. RESULTS: CT findings known to be useful in differentiating tuberculous pleural effusion from empyema (1) contour and extent of pleural thickening, (2) mediastinal pleural involvement, (3)accumulation of extrapleural tissue and (4) change of ipsilateral thoraic volume of empyema. However, none of the above findings were helpful in the differential diagnosis of empyema. CONCLUSION: The differentation of tubrculous pleurisy from pyogenic empyema may be not possible with CT findings only.
Diagnosis, Differential ; Empyema* ; Humans ; Pleural Effusion* ; Pleurisy ; Tuberculosis, Pleural

A 5-week-old male child was admitted to Tabubil Hospital with a rapidly progressive, fulminating right-sided empyema which necessitated thoracotomy and drainage. The causative organism was a haemolytic Streptococcus.
Acute Disease ; Combined Modality - Therapy ; Empyema - diagnosis ; Infant ; Male ; Streptococcal Infections - diagnosis*

Pyothorax-associated lymphoma is a relatively rare type of lymphoma that occurs in patients who have long histories of tuberculous pleuritis or induced pneumothorax. It is a type of non-Hodgkin's lymphoma of mainly the B-cell phenotype and is strongly associated with Epstein-Barr virus infection. A majority of these cases have been reported in Japan, although some cases have occurred in Western countries. Here, we describe a case of pyothorax-associated lymphoma in a patient with a 30-year history of chronic tuberculous empyema. The patient underwent decortication under the impression of chronic empyema with fistula. The histopathologic diagnosis was a diffuse large B-cell lymphoma associated chronic inflammation.
B-Lymphocytes ; Diagnosis ; Empyema ; Empyema, Tuberculous* ; Fistula ; Herpesvirus 4, Human ; Humans ; Inflammation ; Japan ; Lung ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Phenotype ; Pleurisy ; Pneumothorax

Intracranial subdural empyema is a neurosurgical emergency and an unusual condition which carries a serious incidence of mortality and morbidity if untreated. The subdural empyema developes from varied sources, but paranasal sinus, the ear and the mastoid process are predominantly affected and subtentorial empyema usually originates from otogenic intracranial complication. Its manifestations are variable such as impaired consciousness, headache, hemiparesis, acute fits, pyrexia, meningism, vomiting, papilledema. ophthalmoplegia, hemianopsia and dysphasia. Subtentorial empyema has additional cerebellar dysfunction syndromes. Early accurate diagnosis and surgical drainage are the most important factors affecting the prognosis. Recently, we experienced two cases of subtentorial empyema which were very rare otogenic intracranial complications. These patients were treated with suboccipital craniectomy, but reaccumulations of empyema and subsequent cerebellar abscess in one case occurred. Finally these patients were recovered without neurologic deficits. Reviewing our two cases and the literature, we are going to describe about causes, symptoms and signs, method of diagnosis, treatment and prognosis of subtentorial empyema.
Abscess ; Aphasia ; Cerebellar Diseases ; Consciousness ; Diagnosis ; Drainage ; Ear ; Emergencies ; Empyema* ; Empyema, Subdural ; Fever ; Headache ; Hemianopsia ; Humans ; Incidence ; Mastoid ; Meningism ; Mortality ; Neurologic Manifestations ; Ophthalmoplegia ; Papilledema ; Paresis ; Prognosis ; Vomiting

Propionibacterium acnes is one of the commensals living on the human skin and glands, implicated mainly in acnes, but seldom in deep infection. Pleural empyema is rarely complicated with closed thoracostomy. We experienced 1 case of empyema caused by P. acnes after pleural biopsy and closed thoracostomy through a percutaneous pigtail catheter. A 79-year-old man was admitted for cough, purulent sputum and shortness of breath. Three weeks ago, closed thoracostomy and pleural biopsy were performed to confirm a diagnosis for his recurrent pleural effusion. He had increased amount of right pleural effusion. Through the pigtail catheter, pleural effusion was removed. Gram-positive rods were observed in Gram stain, but not cultured. By 16S rRNA analysis, P. acnes was confirmed as the pathogen. His empyema was repeatedly treated with antibiotics, fibrolysis and irrigation. Pleural decortication was recommended. We report the first case of empyema with P. acnes in Korea, possibly complicated with closed thoracostomy procedures.
Aged ; Anti-Bacterial Agents ; Biopsy ; Catheters ; Cough ; Diagnosis ; Dyspnea ; Empyema ; Empyema, Pleural* ; Gram-Positive Rods ; Humans ; Korea ; Pleural Effusion ; Propionibacterium acnes* ; Propionibacterium* ; Skin ; Sputum ; Thoracostomy ; Thoracotomy

The incidence of deep neck infection has been reduced by modern antibiotic therapy. Life-threatening deep neck infection of odontogenic or upper airway origin may extend to the thorax. Early diagnosis, administration of the potent antibiotics, and complete debridement and drainage are essential to improve the chances for survival in these very ill patients. We report two cases of deep neck infection which were complicated by thoracic infection such as mediastinitis, pericarditis, and empyema as a result of descending infection.
Anti-Bacterial Agents ; Debridement ; Drainage ; Early Diagnosis ; Empyema ; Humans ; Incidence ; Mediastinitis ; Neck* ; Pericarditis ; Thorax

PURPOSE: To assess the utility of 2-[18F] fluoro-2-deoxy-D-glucose (FDG) PET in differentiating malignant and benign diffuse pleural disease, and to compare it with CT. MATERIALS AND METHODS: Both FDG PET and CT scans were performed in 20 consecutive patients with diffuse pleural disease (13 malignant and seven benign cases). In FDG PET, peak standardized uptake value (SUV) as well as visual assessment of abnormally increased uptake in the pleura was evaluated. The results were compared with CT findings. RESULTS: With only visual assessment of PET images, sensitivity, specificity, and accuracy for malignancy were 92%, 43%, and 75%, respectively. With peak SUV of 4.8 or more, the corresponding figures were 100%, 57%, and 85%, respectively, and on CT interpretation, were100%, 57%, and 85%, respectively. Tuberculous empyema simulated malignant pleural disease both on FDG PET (3/6 patients with peak SUV more than 4.8) and CT (3/6 patients). CONCLUSION: For the differentiation of malignant and benign diffuse pleural disease, FDG PET and CT are equally accurate. Combined visual and quantitative assessments of PET images enhance discriminatory ability. Tuberculous empyema simulates malignant pleural disease both on FDG PET and CT.
Diagnosis, Differential* ; Empyema, Tuberculous ; Fluorine ; Humans ; Pleura ; Pleural Diseases* ; Sensitivity and Specificity ; Tomography, X-Ray Computed