Analysis of the Empyema without Pus (Organized Empyema)
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概要
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Patients with a history of artificial pneumothorax or tuberculous pleurisy sometimes develop massive non-purulent collections of semi-solid exudate, necrotic material, or hematomas. During the past 10 year 104 patients with a diagnosis of chronic empyema were treated in our hospital, and five of them (4.8%) were found to have no pus.<BR>Their symptoms differed from those of patients with chronic empyema only in that they had more hemosputum. The fluid obtained by thoracentesis was bloodtinged usually, but occasionally pure blood was withdrawn. No organisms could be cultured.<BR>Chest X-ray showed non-homogeneous clouding of the lower 1/3 to 2/3 of the hemithorax without any fluid level. CT scans resembled those of chronic empyema with patchy calcification in the pleural cavity, but no pleural thickening or fluid.<BR>Four of the five patients were treated successfully two with pleuropneumonectomy, one with decortication, one with extra-periosteal air plombage. The fifth patient died of fungal infection of the thoracic cavity after open drainage.<BR>Histological examination showed capillary hemangiomas with or without signs of inflammation in the thickened pleura. We conclude that exudative non-purulent pleurisy is the result of chronic bleeding from hemangiomas on the pleura.<BR>As the disease progresses infection eventually develops. The damaged pleura should be removed early, since surgery for the late stage of this disease is extremely difficult.
- 特定非営利活動法人 日本呼吸器外科学会の論文