Pediatric Empyema
Introduction
Introduction to Pediatric Embryo Pythroat (pyothorax) refers to the accumulation of pus in the pleural cavity, so it is also known as purulent pleurisy (purulentpleurisy), the most common in infants and young children. After the thoracic puncture fluid is statically deposited for 24 hours in a test tube, 1/10 to 1/2 should be a solid component. Less than 1/10 is called pleural effusion. basic knowledge The proportion of sickness: 0.0052% Susceptible people: children Mode of infection: non-infectious Complications: pericarditis Peritonitis
Cause
Pediatric empyema cause
(1) Causes of the disease
Mainly due to the direct invasion of the pleural or lymphoid tissue by the pathogens in the lung infection, the most common development from pneumonia is not uncommon on the basis of lung abscess and bronchiectasis. In addition, such as mediastinal inflammation, Under-abscess, as well as chest trauma, surgery or puncture, etc. Direct contamination is also possible, sepsis can also be caused, Staphylococcus aureus caused by empyema predominance, streptococcus or pneumococcal pneumonia and empyema, currently in China very few See also, Gram-negative bacillus mixed strain infection can also be seen.
(two) pathogenesis
After the pathogenic bacteria invade the pleura, the wall layer and the viscera quickly undergo extensive inflammatory changes, first oozing out of the slurry, which in turn forms cellulose and inflammatory cell deposits. Due to the proliferation of a large number of bacteria, the exudate becomes turbid and viscous. Or thin pus, pneumococci and Staphylococcus aureus pus thick thick, combined with a large amount of cellulose, easy to cause extensive adhesions, streptococci pus thin, resulting in less adhesion, pleural empyema usually occurs in one On the side, the posterior side of the lower part is more common, and can also be seen between the two leaves, or between the lower lobe and the diaphragm. With the amount of the part and the amount of pus, the compression symptoms are also different, if a large amount of pus is full. If the affected chest is not discharged in time, lung collapse can occur, causing mediastinum and heart displacement, impairing cardiopulmonary function. Due to single or multiple atrial empyema, it affects diaphragmatic movement and lung function, if pus Penetrating the lung tissue, the bronchial pleural effusion can be formed. If the pus penetrates the chest wall, the self-destructive empyema is formed. When the severe lung collapse cannot be recovered for a long time, the thoracic deformity can be formed.
Prevention
Pediatric empyema prevention
Since the majority of suppurative pleurisy is secondary to bacterial pneumonia, antibiotic treatment should be used in the early stage of pneumonia to prevent concurrent suppurative pleurisy.
Complication
Pediatric empyema complications Complications pericarditis peritonitis
The most common complication of empyema is complicated bronchial pleural palsy and tension pus pneumothorax. Local spread can be complicated by pericarditis. Penetrating the diaphragm can cause peritonitis, rupture to the chest wall can cause rib osteomyelitis, and septic complications include purulent meningitis. , arthritis and osteomyelitis, chronic empyema can be combined with malnutrition, anemia, chronic dehydration and amyloidosis.
Symptom
Pediatric empyema symptoms common symptoms high fever chest pain persistent cough nose wing fan shortness of breath pleural effusion septic fever dyspnea respiratory failure
Most of the empyema occurred in the early stage of pneumonia. The initial symptoms were symptoms of pneumonia. Although some patients with pneumonia were treated but not enough, the symptoms of pneumonia improved once, and the symptoms of empyema appeared later. Most of the sick children had high fever. When the baby develops empyema, only moderate dyspnea is aggravated; in older children, heavier symptoms of poisoning and severe dyspnea, cough and chest pain are more obvious. When tension pus is generated, sudden shortness of breath occurs. The nose flaps, cyanosis, irritability, persistent cough, and even apnea, white blood cells are generally raised to (15 ~ 40) × 109 / L (15,000 ~ 40,000 / mm3), with toxic particles, pus chest disease poisoning symptoms Severe, chronic consumption causes early malnutrition and anemia, poor mental health, and indifference to the environment.
According to the pathophysiological changes of empyema, there are generally two cases:
1. There are three common reasons for breathing difficulties:
(1) pleural shock response: the pleura can not adapt to sudden stimulation, need to calm, rest, not puncture decompression.
(2) Pulmonary compression: The lungs are severely compressed, the mediastinum is displaced, and drainage is required.
(3) toxic shock: breathing is smooth, the amount of breathing is not reduced, but still manifested as hypoxia, is caused by circulatory failure, urgent need for blood transfusion, infusion, anti-infection and cardiac treatment.
2. High fever does not retreat the chest empyema tension, a large amount of toxin absorption, poisoning is obvious, local high pressure is easy to spread the infection, should be early drainage, no empyema, no tension, mainly infiltration, surgical drainage does not help fever.
Examine
Pediatric empyema examination
1. Blood examination: blood routine leukocytosis, up to (15 ~ 40) × 109 / L, neutrophils up to 80%, visible poisoning particles in white blood cells, can appear nuclear left shift, blood leukocyte alkaline phosphatase and Serum C-reactive protein is elevated.
2. Pathogen examination: the diagnosis of empyema must be done with thoracic puncture, and for smear microscopy, bacterial culture and antibiotic susceptibility test, according to the effective antibiotic treatment.
3. X-ray examination: The amount and location of pleural effusion varies.
4. Ultrasonic examination: visible effluent reflected wave, can clear the effusion range and can make accurate positioning, help to determine the puncture site.
Diagnosis
Diagnosis and diagnosis of pediatric empyema
diagnosis
The clinical manifestations of neonatal empyema are more lacking in characteristics. If you have difficulty breathing, you should carefully check the chest when you have periorbital fistula. The affected side is full of thorax, the intercostal space is widened, the respiratory movement is weakened, and the trachea and heart are shifted to the healthy side. There are voiced or real sounds in the percussion, the vocal tremor is reduced, the breath sound is reduced or completely disappeared, indicating that there is pleural effusion, and further X-ray examination is required. The neonatal's limited ability to inflammation is easy, complicated with sepsis, chest wall infection, and even breathing. Depletion.
According to severe symptoms of poisoning, difficulty in breathing, tracheal and heart sounds are shifted to the contralateral side, and the diseased side has a large voiced sound, and the breath sound is significantly reduced. It can be roughly diagnosed as empyema, and chest X-ray examination can confirm the chest cavity. There is effusion, the X-ray signs of the effusion are evenly dark shadows on the chest, the lungs are mostly covered, and the mediastinum is obviously pushed to the opposite side. The standing position shows that the rib angle disappears or the diaphragm muscle movement is limited, sometimes the lower part of the chest Arc-shaped shadows can be seen in the empyema. The gas-liquid plane can be seen in the case of purulent pneumothorax. The flaky shadow on the edge may be wrapped empyema. When the pus is between the lungs, the lateral X-ray shows the fusiform shadow between the leaves. When examining the empyema line, the site of the empyema should also be clarified, and the reference should be given for treatment. When the chest is fluoroscopy, the body is transferred from the posterior anterior to the lateral position, and the pus can be judged to remain in the upper or lower part of the chest. Front, rear, inside or side.
The diagnosis of empyema must be based on thoracic puncture. The nature of pus is generally related to the pathogen. From the appearance of the obtained pus, the type of pathogen can be presumed to be presumed. The person caused by Staphylococcus aureus is very sticky and yellow. Or yellow-green, yellow-green pus is mostly pneumococcal; staphylococcus is also thicker and yellow; streptococcus caused by pus thin, pale yellow, rice soup; green smelly pus is often anaerobic Bacteria, chest pus should be cultured and tested for drug sensitivity, based on the choice of antibiotics.
Differential diagnosis
The empyema often has to be differentiated from the following conditions.
1. Extensive lung collapse or pneumonia: The empyema of the empyema expands and the trachea shifts to the opposite side; while the lung collapses and the intercostal space narrows, the trachea is deflected to the affected side, and the puncture has no pus.
2. Giant lung bullae and lung abscess: Especially for newborns, one side of the lungs is all compressed, which is difficult to identify. However, the principle of early treatment is not much different. When there is compression, the puncture and decompression are based on the distribution of lung tissue. The situation can be distinguished. When the empyema is present, the lung tissue is concentrated and compressed in the hilar, while the lung bullae is surrounded by lung tissue and respiratory sounds.
3. : Undetected sputum combined with pneumonia or upper sensation, X-ray chest radiographs see multiple gas liquid shadow (intestinal intrusion) or large liquid surface (stomach intrusion) can be mistaken for pus gas chest, puncture for turbid liquid, mucus, The stool can be clearly diagnosed.
4. Giant underarm abscess: Reactive effusion also occurs in the thoracic cavity, but there is very little lung tissue lesion, no negative pressure after puncture and pus, or negative pressure after inhalation X can be seen in the sputum under the armpit, B-ultrasound may have Helps the positioning of the abscess.
5. Pulmonary hydatid or hepatic hydatid disease penetrates into the thoracic cavity: it can form a special nature of pleurisy or liquid pneumothorax, which can be diagnosed according to the epidemiological history and specificity test of the echinococcosis.
6. Connective tissue disease with pleurisy: Sometimes it is like sepsis with empyema, pleural effusion looks like exudate or thin pus, white blood cells are mainly polymorphonuclear neutrophils, pleural effusion and culture sterility It is absorbed quickly after treatment with adrenocortical hormone.
