Classification (1)

•According to the etiological factor:

•1. Specific.

•2. Nonspecific.

•According to the pathogenic factor:

•1. Primary.

•2. Secondary.

Classification (2)

•According to the clinical course:

•1. Acute.

•2. Chronic.

•According to extension of the process:

•1. Focal.

•2. Wide-spread.

Classification (3)

•According to the presence of lung destruction:

•1. Empyema with destruction of pulmonary tissue.

•2. Empyema without destruction of pulmonary tissue.

•3. Pyopneumothorax.

Classification (4)

•According to communication with environment:

•1. Closed pleural empyema;

•2. Open pleural empyema:

•· bronchopleural fistula;

•· thoracopleural fistula;

•· thoracopleurobronchial fistula;

•· cribrate lung.

Symptomatology

•depends on

•extension of the process,

•reactivity of organism and

•presence of complications

Symptoms-1

•The pain is the sign, which denote the involvement of pleural membranes in the process. Its intensity increases depending on depth of respiration and body position.

•The dyspnea arises from accumulation of a purulent content in a pleural space and exception of particular volume of a pulmonary tissue from respiration

Symptoms-2

•The cough is manifestation of inflammation or purulent and destructive process in a pulmonary tissue.

•Fever to 39-40°C,

•headache,

•sleeplessness,

•general malaise, and

•anorexia – all these are manifestations of intoxication.

Examination

•By palpation – diminished vocal fremitus on the part of lesion.

•At percussion - over the exudate it is possible to reveal short sound with oblique upper contour. Above the exudate – tympanic sound resulting from consolidation of pulmonary tissue.

•By auscultation – diminished or absent sound in a great amount of exudate.

X-ray examination

•roentgenological sign of a focal or wide-spread empyema – the presence of exudate

•The wide-spread pleural empyema manifests by intensive homogeneous shadow in a basal parts with oblique upper contour (Damuaso' line).

•The diaphragmatic dome is failed to observe

The diagnostic program

1.Complaints and history of the disease.

2.Physical findings.

3.Data of chest X-ray (in two planes, if necessary – laterography).

4.Pleural puncture.

5.The microbiological investigation of the exudate for its sensivity to antibiotics.

6.General blood and urine analyses.

7.Biochemical blood analysis.

8.Pleurography (in transferring of the process into chronic form).