Home
|
Inbox
|
Search
|
View Abstract
Empyema Necessitans in the Modern Era: Systematic Review
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A7243 - Empyema Necessitans in the Modern Era: Systematic Review
Author Block: D. S. Kumar1, D. Han1, B. Quon2; 1Department of Internal Medicine, Univ of British Columbia, Vancouver, BC, Canada, 2Div of Respirology, Univ of British Columbia, Vancouver, BC, Canada.
RATIONALE: Empyema Necessitans (EN) refers to a parapneumonic process dissecting out of the pleural space and into structures such as the chest wall, mediastinum, and diaphragm. Previously thought to be a rare disease associated with Tuberculosis, EN has been increasingly recognized in recent literature. To date, there has been no systematic review of the literature characterizing EN, or exploring its presentation and management. In this study, we reviewed all adult cases of EN reported over the last 25 years in order to describe the etiology, clinical features, and management of EN in the modern era.
METHODS: References for this review were identified through searches on PubMed and MedLine Databases from 1990 to 2016, using key words including “Empyema”, “Necessitans”, and “Necessitatis”. This search resulted in a total of 49 articles, encompassing 59 adult cases of EN. Each article was independently reviewed by two of our authors and information relating to the following domains was derived: patient age, gender, country of origin, microbiology, immune status, acuity of symptoms, clinical signs, imaging characteristics, treatment type, and outcomes.
RESULTS: EN was predominantly noted in males (84.7%), and commonly associated with a chronic (> 4 weeks) clinical presentation (44% of patients). Frequently noted signs included enlarging chest wall swelling/mass, localized chest wall pain or erythema. Underlying agents included TB in 40.7% of patients, followed by Gram positives (20.3%) such as MSSA and Actinomyces. Significant underlying immunosuppression (immunosuppressant meds, untreated HIV) was noted in 8% of patients, while large majority were found to have normal immune status (62.7%). Surgical management including VATS, debridement, and lung resection were employed in 50% of cases. Repeated thoracentesis and chest tubes were utilized in 21.4% and 19.6% of patients, respectively. A large majority of patients (80.8%) achieved recovery without any lasting morbidities.
CONCLUSIONS: EN remains a poorly understood clinical entity with no established guidelines. As such, clinical approaches to and management of this condition vary among different centers and depend on the underlying organism, presence of immunosuppression, parenchymal pathology, and response to targeted antibiotics. This systematic review serves as a resource for clinicians who may encounter this disease in practice.
Author Block: D. S. Kumar1, D. Han1, B. Quon2; 1Department of Internal Medicine, Univ of British Columbia, Vancouver, BC, Canada, 2Div of Respirology, Univ of British Columbia, Vancouver, BC, Canada.
RATIONALE: Empyema Necessitans (EN) refers to a parapneumonic process dissecting out of the pleural space and into structures such as the chest wall, mediastinum, and diaphragm. Previously thought to be a rare disease associated with Tuberculosis, EN has been increasingly recognized in recent literature. To date, there has been no systematic review of the literature characterizing EN, or exploring its presentation and management. In this study, we reviewed all adult cases of EN reported over the last 25 years in order to describe the etiology, clinical features, and management of EN in the modern era.
METHODS: References for this review were identified through searches on PubMed and MedLine Databases from 1990 to 2016, using key words including “Empyema”, “Necessitans”, and “Necessitatis”. This search resulted in a total of 49 articles, encompassing 59 adult cases of EN. Each article was independently reviewed by two of our authors and information relating to the following domains was derived: patient age, gender, country of origin, microbiology, immune status, acuity of symptoms, clinical signs, imaging characteristics, treatment type, and outcomes.
RESULTS: EN was predominantly noted in males (84.7%), and commonly associated with a chronic (> 4 weeks) clinical presentation (44% of patients). Frequently noted signs included enlarging chest wall swelling/mass, localized chest wall pain or erythema. Underlying agents included TB in 40.7% of patients, followed by Gram positives (20.3%) such as MSSA and Actinomyces. Significant underlying immunosuppression (immunosuppressant meds, untreated HIV) was noted in 8% of patients, while large majority were found to have normal immune status (62.7%). Surgical management including VATS, debridement, and lung resection were employed in 50% of cases. Repeated thoracentesis and chest tubes were utilized in 21.4% and 19.6% of patients, respectively. A large majority of patients (80.8%) achieved recovery without any lasting morbidities.
CONCLUSIONS: EN remains a poorly understood clinical entity with no established guidelines. As such, clinical approaches to and management of this condition vary among different centers and depend on the underlying organism, presence of immunosuppression, parenchymal pathology, and response to targeted antibiotics. This systematic review serves as a resource for clinicians who may encounter this disease in practice.
|
Home
|
Inbox
|
Search
|