Pleural infection-current diagnosis and management

Abstract

Pleural infection is a common and increasing clinical problem in thoracic medicine, resulting in significant morbidity and mortality. In recent years there has been a marked increase in interests and publications relating to evolving interventions and management options for pleural infection and empyema. Recently published research data as well as guidelines have suggested better approaches of radiological assessment, updated management algorithms for pleural infection, intrapleural adjunct therapies and re-examined the roles of biomarkers, pleural drainage techniques, and the role of surgery. This review highlights some of the recent advances and recommendations relevant to clinical care of pleural infection.

Keywords: Pleural effusion; disease management; empyema; infection.

Figure 1

Ultrasound of a patient presenting with Right Middle Lobe pneumonia. Pleural ultrasound can differentiate the consolidated lung (in hepatization phase - white arrow) from adjacent small parapneumonic effusion (arrowhead).

Figure 2

A: This patient presented with a pneumococcal pneumonia which was complicated by pleural infection. A small bore tube was inserted but drainage was limited by extensive septations within the effusion. The patient remained febrile with elevated inflammatory markers; B: Intrapleural tPA and DNase was administered twice daily for three days with dramatic clearance of the loculated effusion. Her fever and inflammatory markers settled and was discharged on antibiotics; C: CXR at 3 months after discharge, with marked improvement of pleural opacities.