MG, a 73-year old female presented to St Vincents Emergency Department, with a 3 week history of progressive dyspnoea, cough, and lethargy, on a background of a 6-year history of Multiple Myeloma. Just prior to presentation, she had also developed a fever.
In terms of her presenting complaint, MG described herself as an active lady, who ran her own pub, but her recent symptoms rendered her unable to carry out her normal activities, such that her husband recommended she should go to hospital.
Following subsequent investigations, MG was diagnosed with bilateral pneumonia and empyema, and was admitted. Once stabilized, she underwent a left thoracotomy with decortication. As a result 2 drains were inserted, with each draining serosanguinous fluid. The plan is to remove these once they have drained < 20 ml in 24 hours.
Past medical history:
• Multiple Myeloma
Past surgical history:
• Autograft bone marrow transplant
• No known drug allergies
• Lives with husband
• Occasional drinker
Family history: non-contributory
System review: non-contributory
• Basal crepitations on left side
• Cardiovascular and abdominal examinations normal
Discussion: Empyema is, by definition, a collection of pus in the pleural space, which most commonly occurs as a result of pneumonia . Three stages in the natural evolution of disease have been outlined by the American Thoracic Society: the exudative, fibrinopurulent and organizing phases. The development of empyema with pneumonia starts with a simple exudation and progresses into the organizing phase . Exudative fluid in this condition, derived from the intertial fluid, is usually not infective.
The evolution of empyema treatment has been well documented for centuries, with reports first recorded by Hippocrates . Treatment is currently based on whether it is, having satisfied the criteria for diagnosis (e.g. pH, lactate dehydrogenase level, glucose level, pleural fluid culture showing bacteria etc), acute or chronic empyema. Though there is...