Pyopneumothorax is a potentially life-threatening condition marked by the presence of pus and air within the pleural cavity.
Presentation
Pyopneumothorax could arise as a progression of either underlying hydropneumothorax or empyema. Therefore, etiological agents that cause these conditions could also play a role in the evolution of pyopneumothorax [1].
Symptoms of pyopneumothorax overlap with the symptoms seen in any severe lung infection and correlate with the degree of lung collapse on the ipsilateral side. Patients may present with pleuritic chest pain, severe cough and dyspnea, whilst also manifesting certain nonspecific symptoms such as fever, loss of appetite, loss of weight, and night sweats.
A recent history of pneumonia, pleural drainage, or penetrating injury may also be suggestive of the diagnosis [2] [3].
A variety of risk factors predisposing to pleural effusion or empyema that may progress to pyopneumothorax have been identified. Some of these predisposing factors are chronic lung disease, gastrointestinal reflux, and immunosuppression. Laboratory findings such as platelets >400 X 10*9, albumin < 30 g/L, sodium < 130 mmol/L and C-reactive protein >100 mg/L, and a history of either alcohol or drug abuse, suggests an increased risk of purulent pleural complications in patients admitted for community-acquired pneumonia [4].
Physical examination may reveal tachypnea, egophony, a dull note on percussion, decreased or absent breath sounds, rales, and rhonchi [5].
Entire Body System
- Fever
The presence of fever may mandate a blood culture. Chest radiography is of prime importance for the differential diagnosis of pneumonia, pulmonary abscess, and empyema. [symptoma.com]
On physical examination fever (39.2°C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. [tandfonline.com]
We report an unusual complication of chronic foreign body aspiration--pyopneumothorax--in a 52-year-old patient presenting with productive cough and intermittent fever for more than 3 months. [ncbi.nlm.nih.gov]
In about 36 hours, the fever disappeared, and the respiratory symptoms improved. In 48 hours, greater than 3000 mL of fluid was evacuated. [thoracickey.com]
We report the case of a 35-year-old male patient who was admitted to the Internal Medicine Department for symptoms of fever associated with coughing and purulent sputum. [elsevier.es]
- Inflammation
Kerosene aspiration leads to inflammation and loss of surfactant. Secondary effects in the lungs include pneumothorax, pneumatocele or bronchopleural fistula. Here, we are presenting a case of pyopneumothorax after kerosene consumption. [ncbi.nlm.nih.gov]
Computed tomography scan of the neck revealed swelling and enhancement of the sternocleidomastoid muscle with loculated fluid collection, inflammation in the left anterior medial neck displacing the trachea extending into the mediastinum and the left [tandfonline.com]
040021, 炎症, エンショウ(ビョウキ), inflammation, 010541, エンショウ, 細菌感染症, サイキンカンセンショウ, bacterial infection(disease), 012784, bacterial infection, 感染症, カンセンショウ, infectious disease, 023297, 胸膜疾患, キョウマクシッカン(ロクマク), pleural disease, 054511, キョウマクシッカン, 胸部疾患, キョウブシッカン [togodb.biosciencedbc.jp]
ICD-10-CM J86.0 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 177 Respiratory infections and inflammations with mcc 178 Respiratory infections and inflammations with cc 179 Respiratory infections and inflammations without cc/mcc 793 Full [icd10data.com]
Abnormal findings include increased bronchovascular markings from peribronchial fibrosis and intrabronchial secretions, tram lines (parallel lines outlining dilated bronchi due to peribronchial inflammation and fibrosis), honeycombing, cystic areas with [eurorad.org]
- Swelling
On physical examination fever (39.2°C), exudative pharyngitis, tenderness and swelling in the left anterior cervical area were noted. [tandfonline.com]
Reported here is an infant who presented with a swelling apparently looking like an external laryngocoele but was finally diagnosed as an apical pneumatocoele communicating with pyopneumothorax. [ncbi.nlm.nih.gov]
Thick greenish-yellow pus was aspirated from the subcutaneous forearm swelling. Pus smear showed necrotic material with degenerated neutrophils and Gram-positive cocci. [lungindia.com]
CASE REPORT A 42-years-old male presented with complaints of multiple episodes of vomiting followed by development of painful swelling of neck, pain and difficulty while swallowing and hoarseness of voice. [journals.lww.com]
- Chills
He denied fever and chills but reported not being able to lie down because of right pleuritic pain and shortness of breath. His medical history was otherwise unremarkable. [deepdyve.com]
At that time, the patient was afebrile without chills or sweats. [consultant360.com]
- Weakness
He presented with progressive weakness and tachypnea. He denied fever and chills but reported not being able to lie down because of right pleuritic pain and shortness of breath. His medical history was otherwise unremarkable. [deepdyve.com]
After one week of taking the ATD, the patient complained of nausea, vomiting, decreased appetite, body weakness, jaundice and there was an increase in transaminases and bilirubin. [microbiologyjournal.org]
Respiratoric
- Tachypnea
He presented with progressive weakness and tachypnea. He denied fever and chills but reported not being able to lie down because of right pleuritic pain and shortness of breath. His medical history was otherwise unremarkable. [deepdyve.com]
Physical examination may reveal tachypnea, egophony, a dull note on percussion, decreased or absent breath sounds, rales, and rhonchi. Laboratory and imaging techniques can be used to confirm the diagnosis. [symptoma.com]
Evaluation revealed a febrile patient (101°F) with tachycardia (110/min), tachypnea (30/min), crepitus over neck and anterior chest wall on left side and stony dull percussion note with absent breath sound over left side of chest. [journals.lww.com]
- Decreased Breath Sounds
Physical examination showed decreased breath sounds and dullness to percussion over the left hemithorax. [journal.chestnet.org]
Decreased breath sounds left side.. Stony dullness on percussion on left side... On pleural fluid tapping pus mixed with blood was drained... [dailyrounds.org]
On auscultation, there were decreased breath sounds and amphoric breath sounds in both infra-axillary regions. Laboratory investigations revealed total leukocyte count (TLC) of 27000/mm 3 with 90% polymorphs. [lungindia.com]
Reduced respiratory motility, decreased breathing sounds, and wet rales were observed on the right side. Both the lower extremities were moderately edematous. His right limb muscle strength was of grade V. [dovepress.com]
- Pleural Disorder
Pleural effusions are the most common pleural disorders arising from a wide spectrum of pathologies. [apamedcentral.org]
Pleural Effusion. https://www.merckmanuals.com/professional/pulmonary-disorders/mediastinal-and-pleural-disorders/pleural-effusion (10.04.2021). Shaw JA, Irusen EM, Diacon AH, et al. Pleural tuberculosis: A concise clinical review. [journals.viamedica.pl]
disorders caused by Trichomonas are being diagnosed more often than before. [dovepress.com]
- Respiratory Distress
A previously healthy 45-year-old man visited our ED because of a 1-day history of respiratory distress. He had been the driver of a car involved in a motor vehicle accident 6 days earlier. [deepdyve.com]
Seven year 18 kg female, a known case of cystic fibrosis, presented in the paediatric casuality with the chief complaints of fever, cough along with an episode of blood tinged sputum for last 20 days and left sided chest pain with respiratory distress [ijaweb.org]
European Respiratory Journal Sep 2006, 28 (3) 637-650 ↑ Khalid F. Almoosa, et al. [physio-pedia.com]
- Sneezing
Perforation of the piriform sinus after sneezing with cervical subcutaneous emphysema and pneumomediastinum Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:147–9 Cited Here | PubMed 3. Jones WG 2nd, Ginsberg RJ. [journals.lww.com]
Perforation of the piriform sinus after sneezing with cervical subcutaneous emphysema and pneumomediastinum. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128:147–9. [PubMed] [Google Scholar] 3. Jones WG 2nd, Ginsberg RJ. [ncbi.nlm.nih.gov]
Perforation of the piriform sinus after sneezing with cervical subcutaneous emphysema and pneumomediastinum. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:147-9. 3. Jones WG 2 nd, Ginsberg RJ. Esophageal perforation: A continuing challenge. [lungindia.com]
Gastrointestinal
- Vomiting
[4] Pyriform sinus is at increased risk of rupture during retching or vomiting due to absence of reinforcing longitudinal muscle layer. [journals.lww.com]
We report a case of rupture of pyriform sinus following multiple episodes of vomiting with subsequent development of pyopneumothorax. [ncbi.nlm.nih.gov]
Unfortunately, she complained of aggravating nausea and vomiting after one week of consuming those three ATD, along with an increase in transaminases level (Table 2). [microbiologyjournal.org]
After DILI resolved, standard 6-month treatment (2HRZE/4HR) was continued, but the patient experienced nausea, vomiting, icteric sclera, and an elevation of transaminases. [scholar.unair.ac.id]
- Nausea
On a follow-up visit 2 weeks later, the patient did not complain of either shortness of breath or nausea and her vital signs were stable. [microbiologyjournal.org]
After DILI resolved, standard 6-month treatment (2HRZE/4HR) was continued, but the patient experienced nausea, vomiting, icteric sclera, and an elevation of transaminases. [scholar.unair.ac.id]
He denied symptoms of chest tightness, nausea, and vomiting. He had taken oral amoxicillin without obvious effect, and the symptoms of fever and chest pain continued. [jmedicalcasereports.biomedcentral.com]
On day 8 of hospitalization, the patient experienced nausea and vomiting during the intravenous infusion of metronidazole, which was considered an adverse drug reaction. [dovepress.com]
- Dysphagia
[1] Subcutaneous emphysema, odynophagia, dysphagia and hoarseness were seen in our patient. [journals.lww.com]
[…] hemoptysis. [1] Subcutaneous emphysema, odynophagia, dysphagia and hoarseness were seen in our patient. [lungindia.com]
- Odynophagia
[1] Subcutaneous emphysema, odynophagia, dysphagia and hoarseness were seen in our patient. [journals.lww.com]
[…] hemoptysis. [1] Subcutaneous emphysema, odynophagia, dysphagia and hoarseness were seen in our patient. [lungindia.com]
Cardiovascular
- Tachycardia
On this admission examination revealed tachycardia with pulse of 120/ min. and regular, pyrexia of 38 degree C, hypoxia with oxygen saturation of 89 % on air, respiratory rate 30 / minute and blood pressure 120/75 mm Hg. [eurorad.org]
Evaluation revealed a febrile patient (101°F) with tachycardia (110/min), tachypnea (30/min), crepitus over neck and anterior chest wall on left side and stony dull percussion note with absent breath sound over left side of chest. [journals.lww.com]
Treatment may be determined by the severity of symptoms and indicators: Acute illness - shortness of breath, tachycardia, reduction in O2 saturation, Presence of underlying lung disease such as COPD estimated size of the pneumothorax on X-ray in some [physio-pedia.com]
Musculoskeletal
- Fracture
No chest wall tenderness or radiographic evidence of rib fracture was noted initially. However, the patient alluded to the development of pleuritic pain on the right side of his chest later. He presented with progressive weakness and tachypnea. [deepdyve.com]
Revue Medicale de Liege 59(3): 118-119, 2004 Treatment of fractured spine with injured spinal cord, according to experiences of the Health Center at Ostrava. [eurekamag.com]
The patient was a 29-year-old White male smoker (15 pack-years) who was a moderate drinker and had a personal history of fracture of the left tibia, for which he had undergone surgery 8 years prior. [scielo.br]
Other traumatic factors may also lead to pneumothorax and eventually lung collapse[4]: Injury or trauma to the chest area: Bullet or stab wounds, fractured ribs, or a blunt force injury can cause the lungs to collapse. [physio-pedia.com]
- Neck Pain
CASE REPORT A 42-years-old male presented with complaints of multiple episodes of vomiting followed by development of painful swelling of neck, pain and difficulty while swallowing and hoarseness of voice. [journals.lww.com]
A 42-years-old male presented with complaints of multiple episodes of vomiting followed by development of painful swelling of neck, pain and difficulty while swallowing and hoarseness of voice. [lungindia.com]
Face, Head & Neck
- Neck Swelling
She then developed a left neck swelling, followed by difficult swallowing and cough. Subsequently, she developed shortness of breath that became severe. [tandfonline.com]
Neurologic
- Irritability
Kerosene vapours may be mildly irritating to the respiratory system and spray applications of kerosene may provoke signs of pulmonary irritation such as coughing and dyspnoea. Kerosene aspiration leads to inflammation and loss of surfactant. [ncbi.nlm.nih.gov]
The patient sought treatment at the emergency room due to right-sided pleuritic chest pain for one month and, 15 days later, developed an irritating cough and dyspnea that worsened progressively, without any other accompanying symptoms. [scielo.br]
Agents that irritate the respiratory tract, such as isoflurane or desflurane, should be avoided during the induction of anaesthesia. [ijaweb.org]
Workup
Laboratory and imaging techniques can be used to confirm the diagnosis. Leucocytosis is seen on a complete blood count, with the differential count suggestive of a left shift. Sputum should be collected in order to identify the etiological agent and to exclude tuberculosis. Antibiotic sensitivity testing should further be done on these samples. The presence of fever may mandate a blood culture.
Chest radiography is of prime importance for the differential diagnosis of pneumonia, pulmonary abscess, and empyema. An accurate diagnosis decides the course of future therapy, with pneumonia and lung abscess being treated with antibiotics, while empyema requires surgical evacuation of the pleural cavity [6] [7]. On a chest X-ray, lung abscess usually appears as a single round density with an air-fluid level. The empyema is characterized by the presence of an air-fluid level that extends to the chest wall. This is accompanied by the blunting of the costophrenic angle. Radiography in the lateral decubitus position may help determine whether the pleural collection is mobile or localized.
Chest CT should be performed when the clinical signs are characteristic for lung/pleural infection but the chest radiography is negative. Such a situation may be encountered in patients with immunosuppression. However, a CT-scan should be avoided in children due to the potential risks associated with excessive radiation exposure at a young age [8].
A Doppler ultrasonography may help distinguish a peripheral abscess from empyema by the presence of blood vessels in the tissue surrounding the abscess [9]. An ultrasonography control is needed during needle aspiration and drainage of the pleural cavity to avoid potential complications [10].
Pleural fluid obtained through diagnostic thoracentesis may reveal findings suggestive of an empyema. These pleural fluid characteristics include a purulent character of the fluid, elevated neutrophils, pleural fluid glucose levels < 60 mg/dl, lactate dehydrogenase >1000 IU/ml and the presence of microorganisms on pleural culture.
X-Ray
- Mediastinal Shift
CBP shows leukemoid reaction... 42 thanks, 25 comments 11 May 2016 Thank Share Post Verified response hydropneumothorax vs pyopneumothorax on cxr. with mediastinal shift, narrowing the diagnosis towards malignancy 8 Reply hydropneumothorax 3 Reply find [dailyrounds.org]
A chest tube to drain the pleural space was inserted under sedation and local anaesthesia if any of the following were present: large pleural effusion causing symptoms (pain or tachypnoea) or mediastinal shift; turbid fluid or pus aspirated during pleurocentesis [thefreedictionary.com]
CXR revealed complete white out of left hemithorax and mediastinal shift to opposite side raising the possibility of massive pleural effusion or empyema. CT thorax revealed left pyopneumothorax. [eurorad.org]
Fig. 11.1 Posteroanterior chest radiograph showing a large right hydropneumothorax, without evident mediastinal shift. [thoracickey.com]
- Left Pleural Effusion
Brunei International Medical Journal (Refer to page 34) The radiograph demonstrated a large left pleural effusion with a horizontal upper border indicating the presence of air and fluid, in this case pus. [apamedcentral.org]
Chest computed tomography (CT) showed small left pleural effusion. On admission she was afebrile, tachycardic (100-110 bpm) and other vitals were within normal limits. [journal.chestnet.org]
Serum
- Neutrophilia
Analytically, we observed the following: normochromic normocytic anemia (hemoglobin, 12.6 g/dL); leukocytosis (15,380 cells/mL) with neutrophilia (77.1%); ESR, 103 mm/h; C-reactive protein, 358 mg/dL; blood urea nitrogen, 26 mg/dL; creatinine, 0.6 mg/ [scielo.br]
Laboratory
- Leukocytosis
Laboratory data showed leukocytosis with neutrophil predominance (WBC 25.0 K/uL; 95.0% neutrophils), hemoglobin 11.0 g/dL and abnormal liver function tests (albumin 1.6 g/dL, aspartate aminotransferase 65 U/L, alanine aminotransferase 52 U/L, alkaline [journal.chestnet.org]
Staphylococcal pneumonia can itself be a complication of a bacteremic illness that may manifest in many ways. [2] In our case, polymorphonuclear leukocytosis and subcutaneous abscess showing staphylococcus favored the diagnosis of staphylococcal bacteremia [lungindia.com]
Analytically, we observed the following: normochromic normocytic anemia (hemoglobin, 12.6 g/dL); leukocytosis (15,380 cells/mL) with neutrophilia (77.1%); ESR, 103 mm/h; C-reactive protein, 358 mg/dL; blood urea nitrogen, 26 mg/dL; creatinine, 0.6 mg/ [scielo.br]
Treatment
The first treatment was inadequate, but air leakage was stopped after the second treatment. However, as prolonged purulent discharge was observed, thoracic drainage was continued. [hindawi.com]
The different treatment modalities of pyopneumothorax- Study of 50 cases. International Journal of Medical Science and Public Health. 2013 ; 2(3): 609-912. [imsear.li.mahidol.ac.th]
Tuberculosis pyopneumothorax is a clinical event, which leads to severe complications and a set of treatment challenges. [erj.ersjournals.com]
Similarly, artificial pneumothorax as a method of treatment for chronic pulmonary abscess may rupture the abscess into the pleural space, and so produce pyopneumothorax. [americanjournalofsurgery.com]
Prognosis
TB 2 1993 [The prognosis of the course of pleural empyema and pyopneumothorax]. PT [allie.dbcls.jp]
Treatment and prognosis Large collections require intercostal drainage with antibiotics. [radiopaedia.org]
Tuberculous pneumothorax is a severe pathology which requires other anti tuberculor drugs eventually surgical treatment for drainage and lung decortications to improve their prognosis. Tuberculosis - management Pleura Public health © 2013 ERS [erj.ersjournals.com]
However, regarding prognosis, patients with NTM and RA complications have a 5-year survival rate of 66.1%, which is lower than that of NTM alone [7]. [hindawi.com]
Etiology
Therefore, etiological agents that cause these conditions could also play a role in the evolution of pyopneumothorax. [symptoma.com]
The mycobacterium tuberculosis was the most common etiological factor. The best modality of treatment was intercostal drainage by tube with antibiotic coverage. Conclusion: Tuberculosis is main etiology in country like India. [scopemed.org]
It may be thought of a variant of a thoracic empyema with gas-containing components although the etiology may be different. The patient usually presents with chest pain and fever. Cough and breathing difficulty may be present. [radiopaedia.org]
Epidemiology
In epidemiological studies on NTM in the United States, the incidence of NTM in patients with RA was 19.2 per 105 patient-years. [hindawi.com]
"An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations". Clinical Infectious Diseases. 34 (4): 434–40. doi : 10.1086/338460. [en.wikipedia.org]
Epidemiology of pneumothorax in England. Thorax 2000;55:666-671 ↑ Bascom, R.(2009). ''Pneumothorax''. eMedicine. Retrieved February 22, 2009 from http://emedicine.medscape.com/article/424547-overview ↑ 4.0 4.1 4.2 4.3 BAUMANN, M.H. and NOPPEN, M. [physio-pedia.com]
Varieties of coccidioidal infection in relation to the epidemiology and control of the disease. Am J Public Health 1946;36:1394-1402. 8. Batra P. Pulmonary coccidioidomycosis. J Thorac Imaging 1992;7:29-38. 9. Scully RE, Mark EJ, McNeely WF, et al. [thefreelibrary.com]
According to the local epidemiologic characteristics, differential diagnosis included lung abscess, community-acquired pneumonia, and pulmonary tuberculosis. [jmedicalcasereports.biomedcentral.com]
Pathophysiology
LAM is related in pathophysiology and clinical presentation to the Tuberous Sclerosis Complex (TSC) syndrome. [jtd.amegroups.com]
Prevention
Knowing that a tension pneumothorax can occur with esophageal rupture can help prevent misdiagnosis. [ncbi.nlm.nih.gov]
Prevention of mucus plug formation and removing secretions by the above measures probably prevented in having another episode of pneumothorax in our child. [ijaweb.org]
Empyema therapy is under the competence of the paediatrician and surgeon, and early performed drainage of pleural cavity can prevent the development of complications. [hrcak.srce.hr]
References
- Chen P, Lin X. Images in clinical medicine. Hydropneumothorax. N. Engl. J. Med. 2010;362(3):e9.
- Barmparas G, DuBose J, Teixeira PG, Recinos G, Inaba K, Plurad D. Risk factors for empyema after diaphragmatic injury: results of a National Trauma Databank analysis. J Trauma. 2009;66(6):1672-1676.
- Burgos J, Falco V, Pahissa A. The increasing incidence of empyema. Curr Opin Pulm Med. 2013;19(4):350-356.
- Chalmers JD, Singanayagam A, Murray MP, Scally C, Fawzi A, Hill AT. Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia.Thorax. 2009;64(7):592-597.
- Maskell NA, Batt S, Hedley EL, Davies CW, Gillespie SH, Davies RJ. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006;174(7):817-823.
- Khwaja S, Rosenbaum DH, Paul MC et al. Surgical treatment of thoracic empyema in HIV-infected patients: severity and treatment modality is associated with CD4 count status. Chest. 2005;128 (1): 246-249.
- Desai H, Agrawal A. Pulmonary emergencies: pneumonia, acute respiratory distress syndrome, lung abscess, and empyema. Med Clin North Am. 2012;96(6):1127-1148.
- Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev. 2008;21(2):305-333.
- Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60(Suppl 1):1-21.
- Chen HJ, Yu YH, Tu CY, Chen CH, Hsia TC, Tsai KD. Ultrasound in peripheral pulmonary air-fluid lesions. Color Doppler imaging as an aid in differentiating empyema and abscess. Chest. 2009;135(6):1426-1432.