What is Empyema?
Collection of pus in chest cavity is called empyema. It is secondary to bacterial pneumonia. Sometimes,it may be due to tuberculosis. Rarely, it can be secondary to chest trauma and after chest surgery for other conditions.
What are the symptoms of Empyema?
It starts with cough and fever. The fever spikes rise and shortness of breath may follow. The child may have chest pain and loss of appetite. If untreated it may be catastrophic.
How common is the condition?
Approximately one child out of 100 child with pneumonia will have empyema. The incidence increases during cold weather when other respitatory infections are on the rise.
What are the tests to be done?
After thorough clinical examination, the doctor asks for blood counts, X ray chest and Ultrasound of the chest. Occasionally, CT scan of the chest is required.
What is the treatment of empyema?
Drainage of pus is mandatory along with intravenous antibiotics. If the pus is thin or the child is in respiratory distress, chest tube drainage should be done. The currently recommended treatment is VATS (video assisted thoracoscopic surgery) and drainage of empyema in early cases. Thoracotomy and decortication is required for chronic empyema.
What is VATS for empyema?
VATS or thoracoscopic surgery is a type of minimally invasive (key hole) surgery. A 5 mm telescope is inserted in the chest. Thick and solidified pus is completely removed under direct vision. All pus pockets are opened up and complete drainage is ensured. Chest cavity is irrigated with antiseptic solution. Complete lung expansion is confirmed and an intercostal drainage tube is inserted. VATS offers faster recovery and duration of hospitalization is reduced.
What happens after surgery?
The child may require ICU care, blood transfusion and oxygen. Child will require to complete the duration of antibiotic treatment. The chest tube is be removed once the drainage stops and lung is completely expanded. Chest physiotherapy is also required for early recovery.
What is the outcome of surgery?
VATS offers quick recovery and excellent outcome. However, the length of hospitalization may vary.