WGH Schmitt pleural empyema
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96. To repeat: further case of a voluminous pleural empyema. This time, on the left-hemithorax side. The air that has not ascended to the ventral, but is somewhere or other trapped air in the pus, represents a neglected sign for ...
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A difficult possibility for drainage that means a sign for bad prognosis. If the sign of alarm is well understood and will all facilities be activated, there remains a chance to control the situation.

Pleural empyema
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97. As concerns this particular patient, there is only a poor CM (contrast medium) presence: this is due to a kidney insufficiency. However a significant accumulation of 'pleura parietalis” has been the net result. The “pleura visceralis” has been tangentially sliced in the caudal sectors and , because of the subsequently resulting fuzziness of the edges, it is not especially easy to detect.

What, precisely, are the fluffy dense areas within the the empyema (in the pus location )?
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Here we are talking about a build-up of the “cell-detritus”as regards the corresponding sedimentary Leukozyten. This material was, in all probability, partially shaken in the settling-down process of the patient, and then returned slowly to its lowest point.
Crucial: Homogeneity are not compulsory for structure of  an acute, suppurating empyema.

98. Additional right-sided Pleural empyema .

Pleural empyema atelektasis
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Was CM (contrast) employed at all? What complication of the empyema may be displayed? Above all, is it such a complication or an initial illness?
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-    Native series (no CM)
-    Appropriately, the pleurae are less clearly restricted. Because of the significant space-demand of the empyema, an impressive “compression atelektasis” is to be found. This equates to a ventilation of the parenchyma. The bronchi, on the other hand, still contain air; because of their cartilage structure, they are ess compressible and are liberated through the breathing movement and coughing-up  of fluid.

-    This finding is concerned not with the “obturation atelektasis” but far rather with a case of pneumonia. For this very reason, without the detailed knowledge of the course, we are unable to decide whether

compression atelektasis is present through a room-demanding empyema, or whether it is all about a

remaining pneumonia, which became complicated through the empyema is present.

99. In this new case, it is easy to recognise the administration of contrast on the large vessels. The lung is pressed closely together through the room-demanding right-sided empyema; the result is a compression atelektasis.

Empyema atelektasis
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Does the atelektasis enhance CM? Does the “atelektasis” still contain air?
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- The atelektasis in this case certainly contains still enough CM . One may assume that during the total airing, the blood circulation is restricted and checked in a reflectionary manner.–Thereby the enhancement will stop.

- The remainder ventilation is not so clearly-defined as per the previous case, but it is still in place.
(The greak word “ateles” means a type of meat, therefore “air-free” ; it is something of a paradox to speak of a “atelektasis” ; much better would be to speak about a “tendency to atelektasis.”)

In this and in the previous case, there was also this flecked density within the empyema area. This contained a conglomeration of pus cells.

100. A repeat: what are typical discoveries in pleural empyema ?

WGH Schmitt
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How many have you actually recognised in total?
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- Localisation: multi-shaped, multi-sided ,so far rather untypical. To that end, the drainage is difficult or very diffucult.
- The empyema is often not homogenous because of irregular mixed  cell-rich  / protein-rich content.
- The tenacity of the empyema: thereby, a completely atypical distribution of trapped air content.
- One of the complications: the compression atelektasis with the corresponding subsequent infection threat of the lung-parenchyma.