What Are the Common Causes of Blue Pus?

Germs invade the pleural cavity and produce a purulent infection in which the purulent exudate accumulates in the pleural cavity, called empyema. Empyema can be divided into acute and chronic according to the length of the disease. According to the pathogenic bacteria, it can be divided into purulent, tuberculous and special pathogenic empyema. According to the scope of the empyema, it can be divided into full empyema and local empyema.

Basic Information

English name

empyema

Visiting department

Thoracic Surgery

Common locations

Pleural cavity

Common causes

Germs invade the pleural cavity

Common symptoms

Chest pain, cough, dyspnea, etc.

Causes of empyema

Purulent pleural cavity caused by purulent infection of the pleural cavity. Pathogens can enter the pleural cavity through:

1. Pulmonary inflammation, especially pneumonia near the visceral pleura, can spread directly to the pleural cavity.

2. Lung abscess or tuberculosis cavity ruptures directly into the pleural cavity.

3. Trauma to the chest wall, lungs or esophagus.

4. Mediastinal infection spreads to the pleural space, such as spontaneous rupture or perforation of the esophagus.

5. Sub-condylar abscesses spread to the pleural space through the lymphatic vessels.

6. Pathogenic bacteria of bacteremia or sepsis enter the pleural cavity through blood circulation.

7. Iatrogenic infections, such as empyema caused by thoracentesis or surgery.

Before the advent of antibiotics, pneumococci, streptococcus, and staphylococcus were the main pathogens of empyema, and the more common pathogens are staphylococci and certain Gram-negative bacilli, such as Klebsiella, coli Bacillus, Pseudomonas aeruginosa, etc. can also be infected by special pathogenic microorganisms such as tuberculosis, amoeba and actinomycetes.

Empyema clinical manifestations

1. History and symptoms

When empyema is secondary to a lung infection, there is usually a history of acute pneumonia. When the symptoms such as fever caused by pneumonia gradually improve, the patient reappears with symptoms such as high fever, chest pain, sweating, poor appetite, and worsening cough; if it is Cases of acute empyema caused by ulceration of the lung abscess often have sudden and severe chest pain, high fever and dyspnea, and sometimes cyanosis and shock. Such as the sudden occurrence of bronchial-pleural fistula, a large amount of purulent sputum, sometimes bloody sputum.

Chronic empyema is an acute empyema that has not been cured in time for 6 to 8 weeks and has been transferred to the chronic phase. Due to the formation of thicker fibrous plates, the absorption of toxins in the pus is reduced, and the clinical symptoms of acute poisoning are mild. Low fever, fatigue, wasting, anemia, low protein, etc. caused by chronic chronic consumption, and chronic cough, sputum, shortness of breath and chest pain, difficulty breathing during activities.

2. Signs

Patients with acute empyema have an acute face, sometimes unable to lie flat, weakened breathing on the affected side, turbidity on percussion, and auscultation of breathing sounds significantly reduced or disappeared.

In the chronic phase of empyema, the thoracic collapse of the affected side weakens the respiratory movement, the spine bends to the affected side, the trachea and mediastinum move to the affected side, and the percussion is dull or solid, and the auscultation respiratory sound is significantly reduced or disappeared. If combined with bronchopleural fistula, exacerbation of cough may occur when the patient is lying on the contralateral side. Long-term patients may have clubbed fingers (toes).

Empyema

Blood test

The white blood cell count increased, the proportion of neutrophils increased, the nucleus shifted to the left, poisonous granules could be seen, anemia in chronic phase, and hemoglobin and albumin decreased.

2. Thoracentesis fluid test

Early exudate, followed by purulent, partly odorous, white blood cell count (10-15) × 10 ⁹ / L, mainly neutrophils; protein content> 3g / dl, glucose <20mg / dl, coated Staining microscopy can find pathogenic bacteria, culture can determine pathogenic bacteria, drug sensitivity tests are used to guide treatment.

3. Chest X-ray

The early X-rays were similar to the general pleural effusion sign or encapsulated pleural effusion, and the level of gas and fluid was combined with bronchial-pleural fistula. Chronic pleural adhesions, shrinkage of the affected chest volume, narrowing of the intercostal space, displacement of the mediastinum, etc.

4. Lung function test

Chronic phase is restricted ventilatory dysfunction and reduced vital capacity.

5. Sputum color check

When a bronchial-pleural fistula is suspected, 2% to 5ml of 1% methylene blue can be injected into the chest cavity to observe the color of sputum to help diagnosis.

Empyema diagnosis

According to the symptoms, signs, X-ray manifestations, especially the results of chest puncture, the diagnosis can be clearly defined.

Empyema treatment

The treatment principles of acute empyema are anti-infection, draining pus and promoting lung expansion to eliminate the pus cavity, and general treatment is given to the whole body.

General treatment

Should strengthen nutrition, supplement plasma or albumin, maintain water, electrolytes and acid-base balance, and symptomatic treatment.

2. Antimicrobial treatment

According to the results of pleural fluid or blood culture and the results of drug sensitivity tests, effective antibacterial drugs are selected, which are generally administered in combination, in sufficient quantities and intravenously throughout the body. Special bacteria such as tuberculosis bacteria, fungi, and actinomycetes should be given effective anti-cricket programs and anti-fungal treatment.

3. Local treatment of empyema

(1) Early puncture and drainage of pus and elimination of pus cavity are the key to controlling infection. After purifying the pus every time, lavage with physiological saline, and then inject antibiotics, such as gentamicin, into 10 to 15 ml of normal saline for use in the chest cavity, or other antibacterial drugs sensitive to bacteria. Start once a day or between days, depending on the condition later.

(2) If the drainage of pus is poor, the disease progresses, and the toxemia is obvious, or the empyema or pneumothorax with bronchopleural fistula or esophageal pleural fistula can be intercostal intubation or transcostal The bed was intubated for closed drainage of pus, lavage and local antibiotic injection treatment, and the tube was removed after the pus cavity was closed.

4. Treatment of chronic empyema

The principle of treatment of chronic empyema is to improve the general condition of patients, eliminate the causes of chronic empyema, close the empyema cavity, and eliminate infection. This can include:

(1) Correct anemia and malnutrition, improve the nutritional status of the whole body, and can transfusion a small number of times for patients with severe anemia.

(2) Improve the original thoracic drainage, make the drainage more unobstructed, and create conditions for future surgery, so some patients can close the pus cavity.

(3) Pleural fiber plate exfoliation: strip the fiber plates on the parietal and visceral pleura, free the lung tissue from the restraint of the fiber plate, and re-expand, not only eliminate the pus cavity, but also improve the ventilation function of the lung. Is the most ideal operation. However, due to extensive lesions in the lungs or thickened pleura that is too tightly adhered to the lung tissue, the pleural fiber layer cannot often be removed. Therefore, the indications for this operation are relatively strict, and it is only applicable to chronic empyema with no cavities in the lungs, no active lesions, no extensive fibrosis, and lung tissue expansion.

(4) Pleural pneumonectomy: Chronic empyema combined with extensive and severe intrapulmonary lesions, such as cavities, highly narrowed organs and bronchial tubes, or bronchiectasis, require pleural pneumonectomy or pleural lobectomy.

(5) Thoracoplasty: At present, the modified Schede surgery is mostly used, that is, only the parietal fiber plate is removed, and the ribs are removed under the periosteum. The periosteum and intercostal muscles, intercostal nerves and blood vessels are retained, and the intercostal bundle is fixed on the visceral fiber plate. Eliminate pus cavity.