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Epidemiology and management of empyema thoracic by hepatic abscess

Reyna-Sepúlveda, Francisco; Hernández-Guedea, Marco; García-Hernández, Saúl; Sinsel-Ayala, Jessica; Pérez-Rodríguez, Edelmiro; Muñoz-Maldonado, Gerardo





2017, Number 2

2017; 76 (2)






ABSTRACT

Background: Liver abscess (LA) can be classified into two categories: amebic (AA) and pyogenic (PA) abscess. However, the most common cause of LA worldwide is amoebic. Empyema is usually a complication of pneumonia, but may arise from an adjacent infection such as the liver. Objective: To determine the epidemiology and to evaluate the management of patients with empyema by LA. Material and methods: We requested the University Hospital «Dr. José Eleuterio González» the records of 2011-2015 with diagnosis of LA and empyema. Results: Twenty-four patients were diagnosed with diabetes mellitus in 10 (42%). The most common symptom was abdominal pain with 18 (75%) patients, followed by fever and chills with 16 (67%), dyspnea in 12 (50%), with amoebic etiology in 4 (16%) patients and the remaining 20 (83%) was pyogenic. In all patients a thoracostomy tube for empyema drainage was placed, 14 (58%) of patients underwent thoracoscopy and two (8%) mortalities were reported. Discussion: The prevalence of diabetes is associated with a higher mortality in LA. The presentation of most of the cases was late and no patient came with a clinical picture of pneumonia. There are reports of some amoebic LA that cause pleural empyema but very few cases of pyogenic etiology have been documented. Conclusions: The prevalence of Klebsiella pneumoniae with more nonspecific clinical features may explain the delay in diagnosis. We report a lower mortality than previously established.

KEYWORDS

Empyema, liver abscess, epidemiology.

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2017, Number 2

2017; 76 (2)