Chest X-ray presentation of pleural empyema

Pleural puncture

Local anestesia

Needle Positioning

Tactics and choice of treatment

•Pleural drainage

•Intensive antibacterial and antiinflammatory therapy should be immediately instituted

•detoxication therapy (infusion of saline solutions, hemotransfusion, transfusion of proteins, solutions of dextran, haemodes, forced diuresis, hemosorption if necessary), therapy for rising up of immunological resistance of the organism

Pleural drainage

Tactics and choice of treatment

•During the empyema's sanation decreases the amount of pus which discharges out through the drainage. The optimal variant of such course is the liquidation of empyema's cavity, then the drainage must be removed.

•Transferring of the process into the chronic form (10-12 weeks) results in formation of a residual empyema's cavity

surgery

•Operative approach is applied when the process has transferred into the chronic form, that is in case of residual empyema's cavity. Volume of the operation – pleurectomy, decortication of lung

Mediastinitis

•Mediastinitis is an infection affecting the mediastinum.

•It can be a life-threatening condition and requires urgent surgical and medical intervention

Etiology

•Infection originating from structures within the mediastinum.

•Infection descending from the oropharynx through the fascial planes in the neck (eg the carotid space, the prevertebral space). This descending infection is known as descending necrotising mediastinitis.

•A rare fibrotic reaction to granulomatous diseases such as histoplasmosis. This is known as fibrosing mediastinitis.