Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- pneumonia recente
- sintomas constitucionais
- pirexia e calafrios
- macicez à percussão
- redução dos murmúrios vesiculares e da ressonância vocal
- sinais de sepse
Other diagnostic factors
- apresentação subaguda
- tosse produtiva
- dor torácica pleurítica
- dispneia
- instrumentação recente do espaço pleural
Risk factors
- pneumonia
- intervenções iatrogênicas no espaço pleural
- trauma torácico
- pacientes imunocomprometidos
- comorbidade pulmonar
- sexo masculino
- idosos ou muito jovens
Diagnostic tests
1st tests to order
- hemoculturas
- proteína C-reativa
- contagem leucocitária
- perfil metabólico
- radiografia torácica
- ultrassonografia torácica
- toracocentese: aparência do líquido pleural
- toracocentese: odor do líquido pleural
- toracocentese: pH do líquido pleural
- toracocentese: concentração de proteínas totais no líquido pleural
- toracocentese: nível de LDH no líquido pleural
- toracocentese: concentração de glicose no líquido pleural
- toracocentese: diferencial de leucócitos no líquido pleural
- toracocentese: microscopia do líquido pleural, cultura e sensibilidade
Tests to consider
- tomografia computadorizada (TC) torácica com contraste
- ressonância nuclear magnética (RNM) do tórax
- tomografia por emissão de pósitrons (PET)
- reação em cadeia da polimerase do líquido pleural
Treatment algorithm
adultos (resultados da cultura pendentes)
crianças (resultados da cultura pendentes)
adultos (resultados da cultura disponíveis)
crianças (resultados da cultura disponíveis)
Contributors
Authors
Christopher Kapp, MD
Assistant Professor of Medicine, Interventional Pulmonologist
Division of Pulmonary and Critical Care, Section of Interventional Pulmonary
Northwestern Memorial Hospital
Chicago
IL
Disclosures
CK declares that he has no competing interests.
Jeremy Kim, MD
Instructor of Medicine, Interventional Pulmonology Fellow
Division of Pulmonary and Critical Care, Section of Interventional Pulmonary
Northwestern Memorial Hospital
Chicago
IL
Disclosures
JK declares that he has no competing interests.
Acknowledgements
Dr Christopher Kapp and Dr Jeremy Kim would like to gratefully acknowledge Dr Athanasia D. Pataka, Dr Renata L. Riha, Dr Najib M. Rahman, and Dr Eleanor K. Mishra, previous contributors to this topic. ADP, RLR, and EKM declare that they have no competing interests. NMR declares that Roche UK supplied clinical trial supplies and funding for the MIST2 trial that he conducted.
Peer reviewers
Steven Sahn, MD
Professor of Medicine and Director
Division of Pulmonary/Critical Care/Allergy/Sleep Medicine
Medical University of South Carolina
Charleston
SC
Disclosures
SS declares that he has no competing interests.
Nicholas Maskell, MD
Senior Lecturer and Consultant Physician
North Bristol Lung Centre
Southmead Hospital
Bristol
UK
Disclosures
NM declares that he has no competing interests.
Y.C. Gary Lee, MBChB, PhD, FCCP, FRACP
Consultant Chest Physician and Senior Lecturer
Oxford Centre for Respiratory Medicine and University of Oxford Churchill Hospital
Oxford
UK
Disclosures
YCGL declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Список литературы
Основные статьи
Shen KR, Bribriesco A, Crabtree T, et al. The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017 Jun;153(6):e129-46.Полный текст Аннотация
Maskell NA, Davies CW, Nunn AJ, et al. UK controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3;352(9):865-74.Полный текст Аннотация
Canadian Paediatric Society. Paediatric complicated pneumonia: diagnosis and management of empyema. Jan 2024 [internet publication].Полный текст
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Pneumonia
- Derrame parapneumônico não complicado
- Abscesso pulmonar
Больше ОтличияРекомендации
- ACR Appropriateness Criteria: radiologic management of infected fluid collections
- The American Association for Thoracic Surgery consensus guidelines for the management of empyema
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