DEPARTMENT OF INTERNAL

MEDICINE
HASANUDDIN UNIVERSITY

Practical Management of Pleural

Empyema
Faris Azhar
Dr. dr. Erwin Arief, Sp.PD, K-P, Sp.P (K)

Pulmonology Division
Introduction
Pleural empyema, by definition the presence of pus
in the pleural space (not an effusion with organisms
seen on Gram stain or low-pH pleural effusion)

Hippocrates in his aphorisms: “pleuritis that does

not clear up in fourteen days results in empyema”

Today the treatment of empyema can be summarized

as appropriate antibiotic therapy combined with
medical or surgical pleural space drainage.
Epidemiology

Diabetes
Pleural infection affects mellitus
65,000 individuals in the
United States and United Intravenous Alcohol
drug abuse abuse
Kingdom each year and
carries a mortality of
approximately 15%
Risk
Chronic lung
factors Poor dental
An increasing rate of disease hygiene
empyema with a rise in
incidence of 2.8% per year
and 12.4% in 2003
compared to 1995 Rheumatoid
Gastro-
oesophageal
arthritis
reflux
 Iatrogenic Trauma

Complication Bronchial
of obstruction
pneumonia • Tumor
• Foreign body
Empyema
Classification and Clinical Staging

American College of Chest Physicians

Tassi GF, Marchetti GP, Pinelli V, Chiari S. Practical management of pleural empyema. Monaldi Arch Chest Dis. 2010 Sep;73(3):124-9. doi: 10.4081/monaldi.2010.296. PMID:
Classification and Clinical Staging

Light’s criteria for classification of pleural empyema

Divisi, D., Gabriele, F., Barone, M., Zaccagna, G., Francescantonio, W.D., & Crisci, R. (2017). Clinical history and surgical management of parapneumonic empyema what is
the role of video-assisted thoracoscopic surgery (VATS)?
Classification and Clinical Staging

1962 ATS Classification

There are 3 stages or phases:

I. Acute or exudative phase
Lasts for several days and is characterised by an effusion that is free-moving in the pleural
cavity
II. Fibro-purulent phase
Characterised by a reduced endocavitary fibrinolysis which causes fibrin deposition on the
pleural surfaces and by a fluid which is cloudy and viscous
III. Chronic or organised phase
The fibrin and collagen deposition which creates a fibrous thickening of the pleura, a sort of
‘peel’ which traps the lung
Diagnosis
Imaging
Chest X-ray Thorasic Ultrasound
Penuaan Ginjal Manusia
Penuaan Ginjal Manusia
Belum digunakan pada model ginjal
Stabilisasi perisit
Vaskulogenesis
Oposisi penuaan sel

Aktivasi Perisit dan fibrosis Teruji pada model eksperimental

P16INK4a positif Suplementasi antioksidan
Generasi Oksidan Penggunaan agen senolytic
Jalur Signalling Wnt Penghambat untuk menghambat
pemanjangan fase G2/M
Densitas vaskular dan regulasi Suplementasi Klotho
Level PPARY
Expresi Klotho Penggunaan klinis untuk indikasi lain
Kapasitas antioksidan Penggunaan ACEi dan ARB
Agonis PPARy

Faktor yang berhubungan dengan Terapi anti-aging yang potensial di

pathogenesis penuaan ginjal masa depan
Thank You