Diagnostic Performance of 18F-Fluorodeoxyglucose Positron Emission Tomography/CT for Chronic Empyema-Associated Malignancy

Miju Cheon,유장,Seung Hyup Hyun,이경수,Hojoong Kim,김진국,Jae Il Zo,Young Mog Shim,Joon Young Choi 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.8

Objective: The purpose of this study was to evaluate the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM). Materials and Methods: We retrospectively reviewed the 18F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the 18F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed. Results: Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity (p < 0.001) presence of a protruding soft tissue mass (p = 0.002), and involvement of the adjacent structures (p < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994. Conclusion: 18F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate 18F-FDG PET/CT diagnostic criterion for CEAM.

Early Aggressive Surgical Treatment of Multiloculated Empyema

백종현,이영욱,이석수,이장훈,이정철,김명수 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.3

Background: Empyema is the collection of purulent exudate within the pleural space. Overall, 36%–65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. Methods: From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. Results: The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. Conclusion: Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.

Empyema Comlicated by Pyogenic Liver Abscess

( Jeong Ill Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Empyema complicated by transdiaphragmatic extension of pyogenic liver abscess is a very rare complication of liver abscess. Effective drainage with proper antibiotic use is essential for treatment. Reported herein is a rare case of empyema complicated by pyogenic liver abscess. Case: A 58-year-old male was admitted due to fever with RUQ pain. He has been inactive HBV carrier state since 20 years ago. He was acute ill looking appearance. Initial vital signs were: BP 150/90 mmHg, HR 116 beats/min, RR 20 breaths/min, temperature 38.0oC. Laboratory studies revealed WBC 12,590/㎣, hemoglobin 13.5 g/dL, platelet 128,000/㎣, prothrombin time was 17.0 sec (INR of 1.55). CRP 25.6 mg/dl, AST/ALT 84/113 IU/L, total bilirubin 1.85 mg/dL, albumin 2.6 g/dL, r-GTP 53 U/L, ALP 102 U/L. Viral markers were HBsAg(+), anti-HBs(-), anti-HCV(-). Abdominal CT showed about 7x9cm sized septated cystic and low attenuation mass with mild rim enhancement in right heatic lobe posteror aspect. Percutanenous catheter drainage was performed and antibiotic treatment was started. On 6th day of hospitalization, he developed dyspnea. Follow up CT showed newly developed empyema of right lower lung. Chest tube drainage was performed. The cultured pus in liver abacess, empyema and blood samples were positive for K. pneumoniae. On the 20th day of hospitalization, liver function recovered completely to normal and follow up abdominal CT showed marked improved state of liver abscess and disappearance of empyema. Conclusions: It is very rare for pyogenic liver abscesses to expand into the diaphragm and cause empyema. Effective drainage with appropriate antibiotics is essential for successful treatment.

소뇌 천막하 농양 : 2례 보고 Report of 2 cases

최창화,이영우 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.3

Intracranial subdural empyema is a neurosurgical emergency and an unusual condition which carries a serious incidence of mortality and morbidity if untreated. The subdural empyema developes from varied sources, but paranasal sinus, the ear and the mastoid process are predominantly affected and subtentorial empyema usually originates from otogenic intracranial complication. Its manifestations are variable such as impaired consciousness, headache, hemiparesis, acute fits, pyrexia, meningism, vomiting, papilledema, ophthalmoplegia, hemianopsia and dysphasia. Subtentorial empyema has additional cerebellar dysfunction syndromes. Early accurate diagnosis and surgical drainage are the most important factors affecting the prognosis. Recently, we experienced two cases of subtentorial empyema which were very rare otogenic intracranial complications. These patients were treated with suboccipital craniectomy, but reaccumulations of empyema and subsquent cerebellar abscess in one case occurred. Finally these patients were recovered without neurologic deficites. Reviewing our two cases and the literature, we are going to describe about causes, symptomes and signs, method of diagnosis, treatment and prognosis of subtentorial empyema.

농흉 환자에서 개방식 배농술 후 흉벽 결손 재건 방법의 선택

문재술,황소민,김기태,남수봉,배용찬,김영대 대한성형외과학회 2004 Archives of Plastic Surgery Vol.31 No.6

The purpose of reconstruction of chest wall defect after open drainage in chronic empyema is the control and prevention of recurrent infection, obliteration of dead space in thoracic cavity, and coverage of open wound. For the obliteration of empyema cavities, latissimus dorsi, pectoralis major or rectus abdominis flaps are commonly used. Among them, latissimus dorsi flap based on thoracodorsal pedicle is most versatile and most reliable. If the latissimus dorsi flap can not be used, the author uses pectoralis major flap or rectus abdominis flap depending on the location and the size of dead space and skin defect. The author reports the results of eight patients who underwent reconstruction of chest wall defect with bronchopleural fistula in empyema using muscle flaps. The author performed 4 latissimus dorsi flaps, 3 pectoralis major flaps, 1 rectus abdominis flap according to various situations. According to the size of dead space and skin defect, the author also performed deepithelized musculocutaneous flap, musculocutaneous flap or muscle flap respectively. During the follow-up period, recurrence of empyema, flap survival, morbidity of donor site and patient's satisfaction were evaluated. There was no recurrence of empyema or wound complication. Also, patients were satisfied with the results of operation. The results demonstrate reliability of various muscle flaps and author's method in selection of reconstruction flap for the chest wall defect after open drainage in empyema.

심폐기능의 이상을 초래한 만성 결핵성 농흉의 치료 -1예 보고-

박준석,최용수,심영목 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.2

Treatment of huge chronic tuberculous empyema with cardiopulmonary dysfunction. Drainage of empyemal space by closed thoracostomy in chronic tuberculous empyema is generally contraindicated because of the possibility of empyema necessitatis and ascending infection. But in case that serious cardiopulmonary dysfunction is present, drainage of empyema and decompression is necessary. We experienced a case in which chronic tuberculous empyema was big enough to cause mediastinal shifting and cardiopulmonary failure. Immediate drainage of pleural cavity with tube thoracostomy was performed. Afterward, pleuropneumonectomy was done following cyclic irrigation for one month. The patient had successful postoperative course without any evidence of complication or relapse of infection. 만성 결핵성 농흉의 치료에 있어서 흉관삽입은 empyema necessitatis 및 상행성 감염의 위험성으로 인해 금기로 간주되어왔다. 하지만 심폐기능의 장애가 존재할 경우 농흉의 배농 및 감압이 필요하다. 본원에서는 만성 결핵성 농흉이 너무 커져 종격동의 편위 및 심폐기능의 이상을 초래한 경우를 경험하였다. 즉각적인 감압을 위해 흉관삽입술을 시행하였고, 한 달간 주기적인 흉강세척을 시행한 후, 전페늑막절제술을 시행하였다. 환자는 성공적으로 치유되었으며, 합병증 및 감염의 재발은 없었다.

국소적 농흉의 비디오 흉강경술에 대한 임상적 고찰

이석기,정민규,김상규,임진수 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Object: Progression of empyema, with the development of fibrinous adhesions and loculations, makes simple drainage difficult or impossible. Different treatment options as available according to the stage and duration of the empvema. The method and time of treatment of localized empyema in videoUassisted thoracoscopic surgery remains controversial. Method: Between April 2002 and December 2003, 16 patients with localized empyema were performed the drainage of localized pleural effusion or empyema, adhesionlysis of fibrous band, and early decortication by video-assisted thoracoscopic surgery (VATS) (group Ⅰ : 13 patients) and minithoracotomy under VATS (group Ⅱ : 3 patients). A retrosptective review was undergone and these data were compared for both groups. Results: VATS was initiated in 16 patients, but conversion to minithoracotomy under VATS (group Ⅱ) was required in 3 patients (19%). Most common bacteria in culture and gram staining was Staphylococcus aureus (31% versus 100%). Mean preoperative length (7.9±3.7days versus 10.0±5.0 days) (P<0.05), interval of chest tube removal (8.7±2.6 days versus 17.3±11.0 days) (P<0.05) and hospital stay (11.2±2.5 days versus 28.0±13.1 days) (P<0.05) were shorter in group Ⅰ. Conclusion: We conclude that videoUassisted thoracic surgery has a relative safe treatment, shorter hospital intervals and period of chest tube. The earlier drainage and dcbridment of loculated empyema (early decortication) with vedioUassisted thoracoscopic surgery is lead to higher success rate of resolving empyema. 배경 : 농흉이 진행이 되면, 섬유화 유착으로 국소적으로 고립이 되면, 흉관 삽입만으로 쉽게 배액되지 않는다. 농흉 기간 및 단계별에 따른 다양한 치료 방법이 있으나, 국소적 농흉에서 비디오흉강경 시기에 대하여 정확한 기준이 없다. 방법 : 2002년 4월부터 2003년 12월까지 국소적 농흉 환자 16명에서 국소적 늑막 삼출액 혹은 농흉을 배액시키고, 섬유소 중격과 유착을 박리하거나 조기 폐박피술을 시행하여, 비디오흉강경군(group I:VATS: 13명)과 최소침습흉부절개술군(group II:minithor- acotomy: 3명)으로 나누어서, 후향적 방법으로 양군간 비교하였다. 결과: 16명 중에서 비디오흉강경술에서 최소침습흉부절개술로 전환한 경우는 3례(19%)였으며, 세균 도말 및 배양 검사에서 Staphylococcus aureus (31% versus 100%)가 가장 많으며, 증상 발현부터 수술 기간(7.9±3.7days versus 10.0±5.0 days) (p<0.05), 흉관 유지 기간(8.7±2.6 days versus 17.3±11.0 days) (p<0.05) 그리고 입원 기간(11.2±2.5 days versus 28.0±13.1 days) (p<0.05)이 group II에 비하여 group I이 더 짧았다. 결론 : 국소적 농흉에서 비디오흉강경술은 비교적 안전하고, 더 짧은 흉관 유지 기간 및 입원 기간을 보여주나, 진단 후 가능한 빨리 비디오 흉강경을 시행한다면 더 좋은 결과가 있을 것으로 사료된다.

Posttraumatic Intracranial Tuberculous Subdural Empyema in a Patient with Skull Fracture

Kim, Jiha,Kim, Choonghyo,Ryu, Young-Joon,Lee, Seung Jin The Korean Neurosurgical Society 2016 Journal of Korean neurosurgical society Vol.59 No.3

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M.tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.

합병부폐렴삼출 및 농흉의 치료성적과 예후인자

김영주 ( Young Joo Kim ),차승익 ( Seung Ick Cha ),권지숙 ( Jee Suk Kwon ),유승수 ( Seung Soo Yoo ),전희정 ( Hee Jung Jun ),김은진 ( Eun Jin Kim ),김창호 ( Chang Ho Kim ),박재용 ( Jae Yong Park ),정태훈 ( Tae Hoon Jung ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.1

연구배경: 폐렴 환자 중 약 40%에서 흉막삼출이 동반되고 이 가운데 약 10%에서 배액이 필요한 합병부폐렴삼출 또는 농흉으로 진행된다. 저자들은 합병부폐렴삼출 및 농흉 환자에서 치료성적과 예후인자에 대해 알아보고자 하였다. 방법: 2001년 9월부터 2005년 12월까지 합병부폐렴삼출 및 농흉으로 치료받았던 115명의 환자를 대상으로 후향적 연구를 시행하였다. 결과: 대상환자 중 101예(87.8%)에서 치료성공을 보였는데 다변량분석에서 흉막액 LDH 수치(OR 7.37; 95% CI, 1.63-33.37; p=0.009)가 치료성공 및 실패에 중요한 예후인자로 나타났다. 해열기간과 유의한 상관관계를 보인 인자로는 흉막액의 농성여부(r=0.236; p=0.01)와 섬유소용해물질 사용빈도(r=0.257; p=0.01)가 확인되었고 입원기간과 유의한 상관관계를 보인 인자는 없었다. 결론: 흉막액 LDH 수치가 합병부폐렴삼출 및 농흉에서 치료성적과 연관된 예후인자로 생각된다. Background: Pleural effusion develops in approximately 40% of pneumonia patients. In 5-10% of these cases, it progresses to complicated parapneumonic effusion (CPPE) or empyema that requires drainage. The prognostic factors of CPPE and empyema remain to be clarified. We examined the treatment outcomes of CPPE and empyema and elucidating their prognostic factors. Methods: One hundred and fifteen patients with CPPE or empyema, who were diagnosed and treated in Kyungpook National University Hospital (Daegu, Korea) between September 2001 and December 2005, were retrospectively analyzed. All the data was acquired from their chart review, and regarding treatment results, the time to defervescence and the length of hospital stay were analyzed. Results: The treatment was successful in 101 patients with a success rate of 87.8%. Multivariate analysis showed the level of pleural fluid lactate dehydrogenase (LDH) to be a significant prognostic factor (odds ratio [OR] 7.37; 95% confidence interval [CI], 1.63 to 33.37; p=0.009). Pussy pleural fluid (r=0.236; p=0.01) and the frequency of urokinase use (r=0.257; p=0.01) correlated with the time to defervescence. However, there was no clinical factor that correlated with the length of hospital stay. Conclusion: The pleural fluid LDH level is a useful prognostic factor for monitoring treatment results of CPPE and empyema. (Tuberc Respir Dis 2007; 63: 24-30)

CASE REPORT : Empyema caused by Clostridium perfringens

( Hyun Sun Park ),( Chul Min Jung ),( Jang Won Choi ),( Yoon Ki Hong ),( Woo Jin Kim ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.1

Pleuropulmonary diseases caused by Clostridial species infections are rare, but have a mortality rate of up to 30%. Furthermore, older people are at greater risk of developing invasive clostridium infections, and the majority of reported cases of clostridium empyema have been attributed to iatrogenic trauma or aspiration. The authors report a case of spontaneous empyema caused by Clostridium perfringens. A 72-year-old woman was admitted to Kangwon National University Hospital for empyema. The patient had no history of trauma, a dental procedure, or aspiration, and was treated using empirical antibiotics and by drainage of pleural fluid. Bacteria species that cause empyema are usually not detected, but on the 4th day of admission, C. perfringens was isolated from the pleural space. The patient was continuously treated with antibiotics for C. perfringens and drainage, and was discharged 25 days after admission with almost a fully recovered status. Increased awareness of Clostrium species infection in the elderly is needed to ensure appropriate treatment.