Tuberculous Empyema

Tuberculous empyema results from Mycobacterium tuberculosis infection of the pleural cavity with purulent exudate accumulation. Acid-fast bacilli are often found in pleural fluid smears or cultures (70%). Chronic empyema often forms due to delayed diagnosis or inadequate treatment. It usually results from rupture of a pulmonary TB cavity or subpleural caseous focus infecting the pleura, occasionally from direct spread of a paravertebral abscess from spinal TB. Post-surgical bronchopleural fistula or pleural cavity infection after pulmonary TB surgery can also cause pyopneumothorax. Additionally, unresolved exudative pleurisy can gradually progress to empyema. Since widespread use of anti-TB drugs, incidence has greatly decreased.

Common Symptoms

Narrowed intercostal space; pleural effusion; dyspnea; hemoptysis; chest tightness; purulent sputum; signs of cardiac tamponade

Causes and Pathogenesis

Etiology and pathogenesis: Incompletely treated tuberculous pleurisy leads to infection via lymphatics or blood, with tuberculous foci invading the pleura causing empyema. Secondary infection of spontaneous pneumothorax from pulmonary TB directly invades the pleura, or rupture introduces bacilli and air causing pyopneumothorax or even bronchopleural fistula. Empyema can also complicate artificial pneumothorax or surgery. Bone or chest wall TB can also invade the pleura. Pathology: Early pleural TB causes acute inflammation, congestion, and exudation with scattered tubercles. Effusions are serous with leukocytes and fibrin, gradually becoming chronic tuberculous empyema with thick, rigid fibrotic pleura often calcified. Fibrotic contraction narrows intercostal spaces, deforms ribs into triangular cross-sections, atrophies intercostal muscles, and deviates the spine to the healthy side. Empyema may be localized or total; it may rupture through intercostal spaces, invade ribs forming cold abscesses, or drain through skin as sinuses.

Treatment

Surgical treatment, drug therapy, supportive therapy

Preventive Measures

1. Actively treat pulmonary infectious foci; 2. Promptly drain pleural effusions; 3. Maintain strict aseptic technique during medical procedures to avoid iatrogenic infection.

Department to Visit

It is recommended to visit the Infectious Diseases department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.