What medical technique is used to diagnose empyema?

The article is professionally consulted by Master, Doctor Nguyen Van Anh - Radiologist - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International Hospital

Empyema means the presence of pus in the pleural cavity. It can be true pus, but it can also be cloudy or light brown fluid that contains dead polymorphonuclear leukocytes (which are the basic components of pus).
The cause of empyema is a complication of infectious diseases in places in the human body such as pleura, lung, abdominal cavity, ... or sepsis.
Based on the lesions on the body, empyema is divided into 2 types: diffuse and localized. But based on the clinical pathology, empyema is divided into acute and chronic. As for the case based on the pathophysiological cause, the disease is classified into primary (infectious origin directly from medical disease, pneumonia) and secondary empyema (including all surgical origin). ).

The signs and symptoms of common empyema are as follows:
Fever, chills and often night sweats, which can be so bothersome that you have to change your shirt several times; Chest pain, shortness of breath, dry cough, weight loss and fatigue; In addition, due to the accumulation of fluid in the pleura, it irritates the diaphragm and nerves in this area, leading to hiccups.

When pleurisy is suspected based on clinical symptoms, the doctor may prescribe methods of chest x-ray or pleural effusion,... to confirm the diagnosis. The use of specific medical techniques are as follows:
Chest X-ray: When using radiographic methods to diagnose empyema, the X-ray image will show a large pleural effusion which is pure opacity. Most of the time, the intercostal space is dilated, the costophrenic angle is lost, and the heart and mediastinum are pushed to the opposite side. If in the later stage, when purulent fluid accumulates in the pleural space, the common radiographic image is a rhomboid shadow at the posterior base of the thorax. Peripheral blood test: When doing a peripheral blood test, it will show an elevated white blood cell count, anemia in the case of a disease for many weeks, an elevated erythrocyte sedimentation rate. Chest CT or ultrasonography can help suggest the diagnosis of empyema, and this method also aims to pinpoint the exact location of the pus compartments before pleural aspiration or placement of drainage.

Pleural puncture : The pleural effusion method shows aspirated pleural pus solid or thin, cloudy yellow or green depending on the bacterial cause. In cases where there are many pus-filled sacs, pleural aspiration may be difficult. If the pus is rotten, it may be due to anaerobic bacteria. Pleural biopsy: Can use needle biopsy method, then take biopsy sample for bacterial culture is also a measure to increase the effectiveness of bacteriology.

If left untreated, empyema cannot absorb and heal on its own. If treated aggressively right from the acute stage, patients can recover after 2-4 weeks, limiting severe sequelae. However, if treatment is not good or untreated, empyema will become chronic, leading to serious complications such as bronchial fistula, rupture of empyema into the esophagus or through the diaphragm into the abdomen.

Empyema can be cured, the treatment includes antibiotics or a combination of antibiotics with needle aspiration or drainage of pleural space. The principle of treatment is to clear the pus, treat the infection, the basic symptom. Specifically:
Purification of pus: Methods of cleaning pus such as pleural aspiration, pleural effusion, closed drainage or surgical dissection of the pleura. Treatment of infections: The treatment of infections is mainly with antibiotics. However, it is necessary to choose the right antibiotic based on the test results of the pathogenic bacteria. Symptomatic treatment: To treat symptoms, patients can perform oxygen therapy, acid-base balance therapy, blood albumin control or fluid therapy. At the same time, it is necessary to ensure nutrition, energy, protein infusion, blood transfusion, and breathing exercises to increase the elasticity of the lung parenchyma. In summary, empyema is a dangerous disease if not diagnosed and treated promptly. Therefore, in order to prevent complications, affect life as well as make it difficult to treat, when noticing signs and symptoms of the disease, patients should go to the doctor for advice on appropriate treatment. . Currently, Vinmec International General Hospital is one of the leading prestigious hospitals in the country, trusted by a large number of patients for medical examination and treatment. Not only the physical system, modern equipment: 6 ultrasound rooms, 4 DR X-ray rooms (1 full-axis machine, 1 light machine, 1 general machine and 1 mammography machine) , 2 DR portable X-ray machines, 2 multi-row CT scanner rooms (1 128 rows and 1 16 arrays), 2 Magnetic resonance imaging rooms (1 3 Tesla and 1 1.5 Tesla), 1 room for 2 levels of interventional angiography and 1 room to measure bone mineral density.... Vinmec is also the place to gather a team of experienced doctors and nurses who will greatly assist in diagnosis and detection. early signs of abnormality in the patient's body. In particular, with a space designed according to 5-star hotel standards, Vinmec ensures to bring the patient the most comfort, friendliness and peace of mind.