Pus in the Chest may Cost You Your Life

You should not be shocked, once you hear your physician cracking news about collection of pus in and around the lung inside your chest. In our country health care delivery system is in such a poor state that thousands of poor and middle class people are walking around while having pus in the chest. Neither our ignorant countrymen are aware of this condition nor medical fraternity does seem to be serious as expected regarding the treatment of this condition where. A patient who is suffering from pus inside the chest neither does not know where to go nor they're anyone who can advise him correctly. The net result is that on one hand this medical condition is overlooked and secondly the possibility of taking a wrong course of treatment increases considerably and in the end it is the only patient who suffers the most and he pays either by losing his lung or by losing his life.

How to identify collection of pus inside the chest?

Such patient suffers from fever all the time, but during the daytime fever is less in degree and does increase rapidly during the evening or nighttime. Along with the fever, patient complains of excessive sweating all the time. There is a desire to cough but on coughing either nothing or a small amount of phlegm comes out.

On coughing patient feels pain in the chest especially on the side of pus collection. If you have suffered from pneumonia infection one month before or you have received previously a chest injury and you find that even after one month of infection or chest injury you are still suffering from cough and fever, do not sit idle and immediately get the chest x-ray done. Remember that a chest x-ray in such a condition should be done in standing position.

On examination of chest x-ray if there is a doubt of pus collection or it shows whitening of one side of the lung, immediately go to an experienced radiologist and get an ultrasound examination of your chest done. There are two advantages of doing chest ultrasound examination, firstly it will confirm the presence of pus or water inside the chest cavity and secondly it will quantify the amount of pus collected therein, so that the correct strategy of treatment may be formulated.

Present Scenario in India

In our country every year about 2lakhs new patients fall victims to this disease. Out of these about 80,000 people lose their lives due to lack of adequate treatment and 60% of those who does survive, die later of complications of this disease. Among older patients, 75% patients of them meet a fatal end. This statistics itself speaks how much we are serious about treatment of this disease in our country, which in medical term called 'empyema thoracis'. This also reflects at what stage our health care delivery system stands and how much we are concerned about this medical condition.

What is this pus collection inside the chest all about?

There is an empty space between chest wall and lung. When we breathe lung expands and fills up completely this empty space. This empty space in medical terms is called `pleural space'. When due to any reason this empty space gets filled up with pus, this condition in medical terms is called 'Empyema thoracics'. Empyema thoracics simply means in common man's language a collection of pus around the lung inside the chest.

Why does pus collect inside the chest?

The most important reason of pus collection inside the chest is an infection of pneumonia. A significant amount of pus-like water collects around the lung. If this infection is not controlled effectively, the same accumulated water in the empty space converts completely into pus.

T.B. infection too emerges a culprit

Second reason in our country for pus collection inside the chest is the tubercular infection in the lung. During the early stage of T.B. infection, yellow-colored water gets collected. If this water gets infected due to outside infection it gets converted into pus. In our country due to repeated removal of this collected water through a syringe and needle, this T.B. water gets converted into pus. If in a T.B. patient the amount of collected water inside the chest is more than 300 ml and if this water is not removed and left as such inside the chest, the possibility of this yellow water getting converted into pus increases considerably. Therefore always remember if there is a T.B. infection in the lung and the amount of collected water around the lung is more than 400 ml, immediately consult a thoracic or a chest surgeon and get that collected water removed through chest tube and continue with ant tubercular medication.

Role of Chest Injury in Causing Pus Collection Inside the Chest

One more important reason of pus collection inside the chest is the chest injury. In road traffic accident, fracture of ribs is a common occurrence and this leads to injury of lung and collection of blood inside the chest. If that collected blood inside the chest is not removed in time, the possibility of catching infection and accumulated old blood converting into pus increases considerably.

There are other reasons for pus collection inside the chest, for example: perforation of a food pipe situated inside the chest due to injury or cancer, infection of back bone or after lung operation due to the development of a condition called B.P.F. (Broncho pleural fistula).

Liver Abscess too Ways a Role

In our country one more reason of pus collection inside the chest, which is very peculiar and specific in our Indian contexts, is the liver abscess. In our country due to bad hygienic habits of eating, people easily fall victim to chronic dysentery and diarrhea. In a patient after recurrent episodes of dysentery and diarrhea for some time, infection reaches the liver and cause pus collection inside the liver. If liver abscess is not treated effectively and timely, the size of pus cavity increases tremendously and ultimately it ruptures. If liver abscess bursts upwards into the chest, the pus starts collecting inside the chest. This is a very dangerous situation. If a timely intervention under supervision of a thoracic surgeon is not done, the patient might die sooner or later.

Where to go if you have a pus collection inside the chest?

If you have come to know about collection of pus inside your chest, immediately consult a thoracic or a chest surgeon. Moving here and there with no proper guidance will result into on one hand waste of money and time; on the other hand it will increase the possibility of destruction of lung. Sometime this delay in treatment may cost the patient his life.

What to do if you have pus collection inside your chest?

If pus collection is of recent onset, consult a thoracic surgeon and get it removed by inserting a tube into the chest and through the tube some special medication, which dissolves the multiple partitions, trapping the lung inside, are administrated into the chest through the chest tube. These medicines are called 'streptokinase' or 'urokinase' or T.P.A. Actually what happens when pus stays inside the chest at a same place for 3-4 days, flimsy partition walls are formed which trap the pus within these partitions? These partitions weave a network around the lung. Because of pus having being trapped between the partitions, the entire collected pus does not come out of the chest through the tube. This procedure is called 'tube thoracostomy' and 'fibrinolysis'.

If the procedure of 'tube thoracostomy' does not yield a desired result then we make 2 or 3 holes inside the chest or through a telescope, partitions are broken down so that the pus can come out of the chest without any obstruction. If this telescopic method fails, a small cut is made on the chest wall and under direct vision all partitions are broken, and after this procedure lung comes back to its original position and is thus saved from destruction. This method of making a cut and cleaning the chest is almost hundred percent effective and successful.

Mismanagement Sometimes Leads to More Problems

It has been observed that in our country when children suffer from pneumonia and pus-like water collects around the lung inside the chest, our child specialist himself tries to take out pus-like water in small quantities through injection at repeated short intervals. Sometimes they themselves put a very narrow tube inside the chest to take out pus, with the result of such things pus is never evacuated from the chest completely. Inadequate removal of pus-like water from the chest cavity creates two main problems, firstly infection is never eradicated, no matter how many strong and effective antibiotics we use and secondly, there is likelihood of developing a medical condition called 'Broncho Pleural Fistula (B.P.F.)'. This condition will result into either loss of lung or loss of life.

Correct Strategy of Treatment in Such Conditions

Therefore always remember if your child is suffering from pneumonia or T.B. infection and pus has collected around the lung and inside the chest, in such a situation you should request your treating chest specialist or physician to seek consultation by a thoracic surgeon and follow his advice and time to time keep on taking his advice otherwise the possibility of lung destruction increases significantly. If pus has been staying inside the chest for more than a week immediately contact a thoracic surgeon and get operated. This operation is called 'empyemectomy decortication'. This special operation is effective and curable in majority of the people. If the pus collection inside the chest has been for more than 8 days never get the pus removed through thoracoscope (telescope), otherwise possibility of irreparable damage to lung as well as dangerous bleeding complication are very likely.

If one month has passed since the collection of pus, the partition formed inside the pus cavity become very hard and constitute a thick and hard layer around the lung. This results into excessive compression of the trapped lung. This compression disturbs the breathing process and destroys the lung completely. In such a situation be careful and consult a thoracic surgeon without any further delay and get yourself operated.

Bronchoscopy

Bronchoscopy is a direct visual examination of the voice box (larynx) and airways through a fiber-optic viewing tube (a bronchoscope). A bronchoscope has a light at the end that allows a doctor to look down through the larger airways (bronchi) into the lung.

Bronchoscopy can help a doctor make a diagnosis and treat certain conditions. A flexible bronchoscope can be used to remove secretions, blood, pus, and foreign bodies; to place medications in specific areas of the lung; and to investigate the source of bleeding. If a doctor suspects lung cancer, the airways can be examined and specimens can be taken from any suspicious areas. Bronchoscopy is used for collecting the organisms that are causing pneumonia and that are difficult to collect and identify in other ways. Bronchoscopy is especially helpful for obtaining specimens in people who have AIDS and other immune deficiencies. When people have been burned or have inhaled smoke, bronchoscopy helps doctors assess the condition of the larynx and airways.

For at least 4 hours before bronchoscopy, the person shouldn't eat or drink. A sedative is often given to ease anxiety, and atropine is given to reduce the risks of a spasm of the voice box and a slowing of the heart rate, which sometimes occur during the procedure. The throat and nasal passage are anesthetized with an anesthetic spray, and then the flexible bronchoscope is passed through the nostril and into the airways of the lungs.

Bronchoalveolar lavage is a procedure doctors can use to collect specimens from the smaller airways that can't be seen through the bronchoscope. After wedging the bronchoscope into a small airway, a doctor instills salt water (saline) through the instrument. The fluid is then suctioned back into the bronchoscope, bringing cells and any bacteria with it. Examination of the material under the microscope helps in diagnosing infections and cancers; culturing the fluid is a better way to diagnose infections. Bronchoalveolar lavage also can be used to treat pulmonary alveolar proteinosish, and other conditions.

Transbronchial lung biopsy involves obtaining a specimen of lung tissue through the bronchial wall. A doctor removes pieces of tissue from a suspicious area by passing a biopsy instrument through a channel in the bronchoscope and then through the wall of a small airway and into the suspicious area of lung. A doctor may use a fluoro-scope for guidance in identifying the suspicious area. Such guidance can also decrease the risk of accidentally perforating the lung and causing a lung collapse (pneumothorax). Although trans-bronchial lung biopsy increases the risk of complications, it often provides additional diagnostic information and may make major surgery unnecessary.

After bronchoscopy, the person is observed for several hours. If a tissue specimen was removed, chest x-rays are taken to check for complications.

Submitted By:
DR. K. K. PANDEY

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Comments

is there any chance of fluid collection in inter-muscular cavity inside chest wall after, chest drain treatment of tuberculosis empyema, not not healing of drain wound becaose of it. will it need surgical treatment for 14 ml. of fluid collection in inter-muscular cavity inside chest wall.

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