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Pleuraempyem

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Thoraxchirurgie

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Beim Pleuraempyem handelt es sich um die Akkumulation von infizierter Flüssigkeit in der Pleurahöhle. Diese Erkrankung betrifft häufiger immunsupprimierte Patienten mit multiplen Begleiterkrankungen. Daher ist in der Regel ein komplexes und interdisziplinäres Management erforderlich. Den Grundpfeiler der Diagnostik bilden die Ergussanalytik und bildgebende Verfahren (Sonografie, Röntgen-Thorax, CT mit Kontrastmittel), aus denen sich das Stadium des Empyems definieren lässt. Die Therapie kann dann aus der Stadieneinteilung sowie der Risikoeinstufung des Patienten abgeleitet werden. Die häufigste Form des Empyems ist das parapneumonische Empyem. Bei Patienten mit einer Pneumonie ist daher die Abklärung eines konsekutiven Pleuraergusses obligat. In der initialen Phase, dem geringgradigen parapneumonischen Erguss, kann eine antimikrobielle Therapie ausreichend sein. Sollte sich ein ausgeprägter Erguss entwickeln, ist die Drainage des Verhaltes indiziert. In den späteren Stadien, bei dem Nachweis von Eiter oder im letzten Stadium, das mit einer Schwartenbildung einhergeht, besteht die Indikation zur operativen Sanierung.

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Literatur

  • Ala-Seppälä HM, Ukkonen MT, Lehtomäki AI, Pohja ES et al (2020) High occurence of Thrombo-Embolic complications during long-term follow-up after pleural infections- a single-center experience with 536 consecutive patients over 17 years. Lung 198:671–678

    Article  PubMed  PubMed Central  Google Scholar 

  • Altmann ES, Crossingham I, Wilson S et al (2019) Intra-pleural fibrinolytic therapy versus placebo, or a different fibrinolytic agent, in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2019:CD002312

    PubMed  PubMed Central  Google Scholar 

  • Andrews NC, Parker EF, Shaw RR et al (1962) Management of non-tuberculosis empyema. Am Rev Respir Dis 85:935–936

    Google Scholar 

  • Bedawi EO, Hassan M, Rahman NM (2018) Recent developments in the management of pleural infection: A comprehensive review. Clin Respir J 12:2309–2320

    Article  PubMed  Google Scholar 

  • Bongiolatti S, Voltolini L, Borgianni S et al (2017) Uniportal thoracoscopic decortation for pleural empyema and the role of ultrasonographic preoperative staging. Interact Cardiovasc Thorac Surg 24:560–566

    PubMed  Google Scholar 

  • Chambers A, Routledge T, Dunning J et al (2010) Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema? Interact Cardiovasc Thorac Surg 11:171–177

    Article  PubMed  Google Scholar 

  • Chan DT, Sihoe AD, Chan S et al (2007) Surgical treatment for empyema thoracis: is video-assisted surgery ‚better‘ than thoracotomy? Ann Thorac Surg 84:225–231

    Article  PubMed  Google Scholar 

  • Chan KP, Fitzgerald DB, Lee YCG (2018) Emerging concepts in pleural infection. Curr Opin Pulm Med 24:367–373

    Article  PubMed  Google Scholar 

  • Colice G, Curtis A, Deslauriers J et al (2000) Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest 118:1158–1171

    Article  CAS  PubMed  Google Scholar 

  • Davies HE, Davies RJO, Davies CWH et al (2010) Management of pleural infections in adults: British Thoracic Society pleural disease guideline. Thorax 65:ii41–ii53

    Article  PubMed  Google Scholar 

  • Dyrhovden R, Nygaard RM, Patel R et al (2019) The bacterial aetiology of pleural empyema. A descriptive and comparative metagenomic study. Clin Microbiol Infect 25:981–986

    Article  CAS  PubMed  Google Scholar 

  • Feller-Kopman D, Light R (2018) Pleural disease. N Engl J Med 378:740–751

    Article  CAS  PubMed  Google Scholar 

  • Ferreriro L, Porcel JM, Toubes ME et al (2018) Management of pleural infections. Expert Rev Respir Med 12:521–535

    Article  Google Scholar 

  • Godfrey MA, Bramley KT, Detterbeck F (2019) Medical and surgical management of empyema. Semin Respir Crit Care Med 40:361–374

    Article  PubMed  Google Scholar 

  • Grijalva CG, Zhu Y, Nuorti JP et al (2011) Emergence of parapneumonic empyema in the USA. Thorax 66:663–668

    Article  PubMed  Google Scholar 

  • Hecker E, Hamouri S (2008) Videoassistierte thorakoskopische Chirurgie (VATS) zur Behandlung des parapneumonischen Pleuraempyems. Zentralbl Chir 133:212–217

    Article  CAS  PubMed  Google Scholar 

  • Hecker E, Hamouri S, Müller E et al (2012) Pleuraempyem und Lungenabszess: Aktuelle Therapiekonzepte. Zentralbl Chir 137:248–256

    Article  CAS  PubMed  Google Scholar 

  • Hecker E, Hecker HC, Hecker KA (2013) Pleuraempyem- Behandlungsstrategien unter Berücksichtigung der Ätiologie. Zentralbl Chir 138:353–379

    Article  CAS  PubMed  Google Scholar 

  • Hicham H, Ibrahim I, Rabiou S et al (2020) Postpneumonectomy empyema: risk factors, prevention, diagnosis, and management. Asian Cardiovasc Thorac Ann 28:89–96

    Article  PubMed  Google Scholar 

  • Höfken H, Herrmann D, Ewig S, Hecker E (2018) Video-assisted thoracoscopic surgery of parapneumonic empyema – a 10-year single-centre experience. Pneumologie 72:843–850

    Article  PubMed  Google Scholar 

  • Hsiao CH, Chen KC, Chen JS (2017) Modified single-port non-intubated video-assisted thoracoscopic decortication in high-risk parapneumonic empyema patients. Surg Endosc 31:1719–1727

    Article  PubMed  Google Scholar 

  • Ismail M, Nachira D, Macci E et al (2018) Uniportal video-assisted thoracic surgery in the treatment of pleural empyema. J Thorac Dis 10:S3696–S3703

    Article  PubMed  PubMed Central  Google Scholar 

  • Keeling AN, Leong S, Logan PM et al (2008) Empyema and effusion: outcome of image-guided small-bore catheter drainage. Cardiovasc Intervent Radiol 31:135–141

    CAS  PubMed  Google Scholar 

  • Lesser T (2019) Die pleurale Residualhöhle nach Lungenresektion. Zentralbl Chir 144:S31–S42

    Article  PubMed  Google Scholar 

  • Light RW (1995) A new classification of parapneumonic effusions and empyema. Chest 108:299–301

    Article  CAS  PubMed  Google Scholar 

  • Lu HY, Liao KM (2018) Risk of empyema in patients with COPD. Int J Chron Obstruct Pulmon Dis 13:317–324

    Article  PubMed  PubMed Central  Google Scholar 

  • Maskell NA, Davies CW, Nunn AJ et al (2005) U.K. controlled trail of intrapleural streptokinase for pleural infection. N Engl J Med 352:865–874

    Article  CAS  PubMed  Google Scholar 

  • Muhammad MI (2012) Management of complicated parapneumonic effusion and empyema using different treatment modalities. Asian Cardiovasc Thorac Ann 20:177–181

    Article  PubMed  Google Scholar 

  • Oberg CL, Majid A (2019) Update on management of pleural disease. Curr Pulmonol Rep 8:205–214

    Article  Google Scholar 

  • Petrakis IE, Kogerakis NE, Drositis IE et al (2004) Video-assisted thoracoscopic surgery for thoracic empyema: primarily, or after fibrinolytic failure? Am J Surg 187:471–474

    Article  PubMed  Google Scholar 

  • Petrov DB, Subotic D, Yankov GS et al (2019) Treatment optimization of post-pneumonectomy pleural empyema. Folia Med (Plovdiv) 61:500–505

    Article  PubMed  Google Scholar 

  • Porcel JM, Pardina M, Alemán C et al (2017) Computed tomography scoring system for discrimination between parapneumonic effusions eventually drained and those cured only with antibiotics: CT for parapneumonic effusions. Respirology 22:1199–1204

    Article  PubMed  Google Scholar 

  • Rahman NM, Maskell NA, Davies CWH et al (2010) The relationship between chest tube size and clinical outcome in pleural infection. Chest 137:536–543

    Article  PubMed  Google Scholar 

  • Rahman NM, Maskell NA, West A et al (2011) Intrapleural use of tissue plasminogen activator and DNase in pleural infection. N Engl J Med 365:518–526

    Article  CAS  PubMed  Google Scholar 

  • Redden MD, Chin TY, van Driel ML (2017) Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev 3:CD010651

    PubMed  Google Scholar 

  • Samancilar O, Akcam TI, Kaya SO et al (2018) The efficacy of VATS and intrapleural fibrinolytic therapy in parapneumonic empyema treatment. Ann Thorac Cardiovasc Surg 24:19–24

    Article  PubMed  PubMed Central  Google Scholar 

  • Scari M, Abah U, Solli P et al (2015) EACTS expert consensus statement for surgical management of pleura empyema. Eur J Cardiothorac Surg 48:642–653

    Article  Google Scholar 

  • Semenkovich TR, Olsen MA, Puri V et al (2018) Current state of empyema management. Ann Thorac Surg 105:1589–1596

    Article  PubMed  PubMed Central  Google Scholar 

  • Shen KR, Bribriesco A, Crabtree T et al (2017) The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg 153:e129–e146

    Article  PubMed  Google Scholar 

  • Shen TC, Chen CH, Huang YJ et al (2018) Risk of pleural empyema in patients with schizophrenia: a nationwide propensity-matched cohort study in Taiwan. BMJ Open 8:e021187

    Article  PubMed  PubMed Central  Google Scholar 

  • Sumalani KK, Rizvi NA, Asghar A (2018) Role of medical thoracscopy in the management of multiloculated empyema. BMC Pulm Med 18:179

    Article  PubMed  PubMed Central  Google Scholar 

  • Sziklavari Z, Hofmann HS (2014) Fünf Jahre Erfahrungen mit intrathorakaler Vakuumtherapie beim Pleuraempyem und Lungenabszess. Zentralbl Chir 139:S01

    Article  Google Scholar 

  • Sziklavari Z, Ried M, Hofmann HS (2015a) Intrathorakale Vakuumtherapie beim Pleuraempyem und Lungenabszess. Zentralbl Chir 140:321–327

    Article  CAS  PubMed  Google Scholar 

  • Sziklavari Z, Ried M, Neu R et al (2015b) Mini-open vacuum-assisted closure therapy with instillation for debilitated and septic patients with pleural empyema. Eur J Cardiothorac Surg 48:e9–e16

    Article  PubMed  Google Scholar 

  • Tong BC, Hanna J, Toloza EM et al (2010) Outcomes of video-assisted thoracoscopic decortication. Ann Thorac Surg 89:220–225

    Article  PubMed  Google Scholar 

  • Tu CY, Chen CH (2012) Spontaneous bacterial empyema. Curr Opin Pulm Med 18:355–358

    Article  CAS  PubMed  Google Scholar 

  • Wait MA, Sharma S, Hohn J et al (1997) A randomized trail of empyema therapy. Chest 111:1548–1551

    Article  CAS  PubMed  Google Scholar 

  • Waller DA, Rengarajan A (2001) Thoracoscopic decortication: a role for video-assisted surgery in the chronic postpneumonic pleural empyema. Ann Thorac Surg 71:1813–1816

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Thoraxzentrum Ruhrgebiet – EVK Herne, Herne, Deutschland

    Dominik Herrmann & Erich Hecker

Authors
  1. Dominik Herrmann
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  2. Erich Hecker
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Corresponding author

Correspondence to Dominik Herrmann .

Editor information

Editors and Affiliations

  1. Sektion Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland

    Hans Hoffmann

  2. Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus, Düsseldorf, Deutschland

    Corinna Ludwig

  3. Klinik für Thoraxchirurgie Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland

    Bernward Passlick

Section Editor information

  1. Klinik für Thoraxchirurgie, Uniklinik Freiburg, Freiburg, Deutschland

    Bernward Passlick

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© 2023 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

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Herrmann, D., Hecker, E. (2023). Pleuraempyem. In: Hoffmann, H., Ludwig, C., Passlick, B. (eds) Thoraxchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59146-8_48

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  • DOI: https://doi.org/10.1007/978-3-662-59146-8_48

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-59145-1

  • Online ISBN: 978-3-662-59146-8

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