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Fulltext Bilateral neonatal breast abscess in a well-appearing neonate

Muhammad Yusoff Mohd Ramdzan, Jamil Aiman Mohd Baharuddin, Nordiyana Azmi, Noraida Ramli, Nor Rosidah Ibrahim, Rostenberghe, Hans Van

Malaysian Journal of Paediatrics and Child Health, 2019;25(1):27-29.
MyJurnal

Neonatal mastitis and abscess are rare and most often unilateral. Neonatal breast massage for physiological breast hypertrophy is suspected to be a predisposing factor in the case reported here: a 14-day-old neonate with bilateral neonatal breast abscess, treated effectively with intravenous cloxacillin and surgical aspiration.

Matched MeSH terms: Empyema, Pleural
Fulltext Massive hemothorax following administration of intrapleural streptokinase

Chai FY, Kuan YC

Ann Thorac Med, 2011 Jul;6(3):149-51.
PMID: 21760848 DOI: 10.4103/1817-1737.82451

The administration of intrapleural streptokinase (IPSK) is widely practiced in the management of loculated empyema thoracis. To our knowledge, there have been only 4 cases of hemorrhagic complications attributed to the administration of IPSK reported in the literature. In this article, we report a case of a 17-year-old girl who received IPSK and developed shock, anemia, coagulopathy and massive hemothorax. Our discussion focuses on the hemorrhagic complication of chest tube insertion and the role of IPSK in blood clot lysis and inhibition of local hemostasis.

Matched MeSH terms: Empyema, Pleural
Two surgical methods used in 90 patients with intracranial subdural empyema

Mat Nayan SA, Mohd Haspani MS, Abd Latiff AZ, Abdullah JM, Abdullah S

J Clin Neurosci, 2009 Dec;16(12):1567-71.
PMID: 19793660 DOI: 10.1016/j.jocn.2009.01.036

We studied the efficacy of two surgical methods used for the treatment of intracranial subdural empyema (ISDE) at our centre. A cross-sectional study (1999-2005) of 90 patients with non-traumatic supratentorial ISDE revealed that the two surgical methods used for empyema removal were burr hole/s and drainage (50 patients, 55.6%) and a cranial bone opening procedure (CBOP) (40 patients, 44.4%). Patients in the CBOP group had a better result in terms of clinical improvement (chi-squared analysis, p=0.006) and clearance of empyema on brain CT scan (chi-squared analysis, p<0.001). Reoperation was more frequent among patients who had undergone burr hole surgery (multiple logistic regression, p<0.001). The outcome and morbidity of ISDE survivors were not related to the surgical method used (p>0.05). The only factor that significantly affected the morbidity of ISDE was level of consciousness at the time of surgery (multiple logistic regression, p<0.001). We conclude that CBOP and evacuation of the empyema is a better surgical method for ISDE than burr hole/s and drainage. Wide cranial opening and empyema evacuation improves neurological status, gives better clearance of the empyema and reduces the need for reoperation. Level of consciousness at the time of presentation is a predictor of the morbidity of ISDE. Thus, aggressive surgical treatment should occur as early as possible, before the patient deteriorates.

Matched MeSH terms: Empyema, Subdural/surgery*
Sphenoethmoid sinusitis in a child resulting in a disastrous intracranial sequela

Sow AJ, Jahendran J, Toh CJ, Kew TY

Ear Nose Throat J, 2012 Nov;91(11):E20-2.
PMID: 23288800

Localized sphenoethmoid sinusitis in children is a rare occurrence. It is usually overlooked because of the misconception that the sinuses are not developed. We describe a case of localized acute sphenoid and right posterior ethmoid sinusitis that presented as right frontobasal subdural empyema and multiple deep cerebral abscesses. Morbidity from subdural empyema in children is high. Early diagnosis and treatment based on recognition that the etiology might involve the paranasal sinuses affects the overall prognosis.

Matched MeSH terms: Empyema, Subdural/etiology*
A Homemade, High-fidelity Ultrasound Model for Simulating Pneumonia with Parapneumonic Effusion and Empyema

James V, Kee CY, Ong GY

J Emerg Med, 2019 Apr;56(4):421-425.
PMID: 30638645 DOI: 10.1016/j.jemermed.2018.12.015

BACKGROUND: Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Unfortunately, most commercial ultrasound phantoms remain expensive and may have limited fidelity.
OBJECTIVE: Our aim was to create and describe a homemade, high-fidelity ultrasound phantom model for demonstrating pneumonia with pleural effusions for teaching purposes.
DISCUSSION: An ultrasound phantom was constructed using a water-filled latex glove with a sliver of meat in it, covered over by a palm-sized piece of meat (skin and ribs are optional to increase ultrasonographic details and realism). This would appear like parapneumonic effusions with organized pneumonia under ultrasound examination. Creamer (or talc) can be added to the water in the glove to simulate empyema. The model can also be used to teach simple effusions and for ultrasound-guided thoracentesis and in clinical decision making.
CONCLUSIONS: Easily prepared, homemade high-fidelity ultrasound phantom models for instructions on identification of pleural effusions and ultrasound-guided pleural tap of parapneumonic effusion were made.

Matched MeSH terms: Empyema/diagnosis*
Infections in post-tsunami victims

Othman N, Ismail IH, Yip R, Zainuddin Z, Kasim SM, Isa R, et al.

Pediatr Infect Dis J, 2007 Oct;26(10):960-1.
PMID: 17901807 DOI: 10.1097/INF.0b013e3181257234

Two tsunami survivors from Banda Acheh, Sumatra, presented with pyrexia of unknown origin and a nonresolving left-sided empyema, respectively. Both children had mixed infections of tuberculosis and melioidosis; Salmonella typhi was also present in the second patient. Mixed infections are common late sequela complications in post-tsunami victims.

Matched MeSH terms: Empyema/microbiology
Fulltext [Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema]

Foo LL, Chaw SH, Chan L, Ganesan D, Karuppiah R

Rev Bras Anestesiol, 2016 09 28;67(6):655-658.
PMID: 27692367 DOI: 10.1016/j.bjan.2015.09.006

Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Matched MeSH terms: Empyema, Subdural/surgery*
Fulltext Correlations between subdural empyema and paraclinical as well as clinical parameters amongst urban malay paediatric patients

Nayan SA, Abdullah MS, Naing NN, Haspani MS, Md Ralib AR

Malays J Med Sci, 2008 Oct;15(4):19-27.
PMID: 22589634 MyJurnal

Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher's Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).

Matched MeSH terms: Empyema; Empyema, Subdural
Fulltext Paediatric one lung anaesthesia by selective bronchial intubation

Lew YS

Singapore Med J, 2000 Aug;41(8):398-400.
PMID: 11256348

One lung anaesthesia in paediatric patients may not always be achievable by bronchial blockade or double lumen tube intubation due to inadequate experiences or facilities. We attempted to isolate right lung by selectively intubating the left bronchus with single lumen tube on a 10 kg child. Optimal surgical condition and satisfactory oxygenation achieved but complicated with severe respiratory acidosis. The possible causes for hypercapnea in this child were discussed.

Matched MeSH terms: Empyema/radiography; Empyema/surgery
Fulltext Bruton's agammaglobulinaemia in a child presenting with cryptococcal empyema thoracis and periauricular pyogenic abscess

Wahab JA, Hanifah MJ, Choo KE

Singapore Med J, 1995 Dec;36(6):686-9.
PMID: 8781652

We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.

Matched MeSH terms: Empyema, Pleural/diagnosis*; Empyema, Pleural/therapy
Fulltext Protective and risk factors for acute respiratory infections in hospitalized urban Malaysian children: a case control study

Azizi BH, Zulkifli HI, Kasim MS

Southeast Asian J Trop Med Public Health, 1995 Jun;26(2):280-5.
PMID: 8629061

We performed a case control study to examine protective and risk factors for acute respiratory infections (ARI) in hospitalized children in Kuala Lumpur. Consecutive children between the ages of one month and five years hospitalized for pneumonia (n = 143), acute bronchiolitis (n = 92), acute laryngotracheobronchitis (n = 32) and empyema (n = 4) were included as cases and were compared with 322 children hospitalized during the same 24 hour period for non-respiratory causes. Potential risk and protective factors were initially analysed by univariate analysis. Logistic regression analysis confirmed that several home environmental factors were significantly associated with ARI. The presence of a coughing sibling (OR = 3.76, 95%CI 2.09, 6.77), a household with more than five members (OR = 1.52, 95%CI 1.03, 2.19) and sleeping with three other persons (OR = 1.45, 95%CI 1.00, 2.08) were independent risk factors. Significant host factors were history of allergy (OR = 2.50, 95%CI 1.74, 3.61) and ethnicity (Malay race) (OR = 2.07 95%CI, 1.27, 3.37). Breast feeding for at least one month was confirmed as an independent protective factor (OR = 0.58, 95%CI 0.38, 0.86). However, the study was not able to demonstrate that domestic air pollution had an adverse effect. This study provides further evidence that home environmental factors, particularly those associated with crowding, may predispose to ARI and that breast feeding is an important protective factor.

Matched MeSH terms: Empyema, Pleural/epidemiology; Empyema, Pleural/prevention & control
Spectra of central nervous system melioidosis

Muthusamy KA, Waran V, Puthucheary SD

J Clin Neurosci, 2007 Dec;14(12):1213-5.
PMID: 17964168

Burkholderia pseudomallei infection of the central nervous system (CNS) is rare with less than 50 cases reported over the last 30 years. The retrospective melioidosis study at University Malaya Medical Centre has documented three cases of CNS melioidosis out of more than 160 cases of melioidosis since 1978. There were two patients with brain abscess and one with spinal epidural abscess. The predisposing factors were: one patient was an aboriginal farmer and the other two were diabetic. Their age ranged from 17 to 45 years. Prominent neurological features were limb weakness, cranial nerve palsy (6th and 7th) and visual disturbance. CT brain scan and MRI spine showed abscess formation, subdural collection, and spinal epidural collection, osteomyelitis of vertebra and occipital bone and also sagital sinus thrombosis. All these patients underwent surgical drainage leading to bacteriological diagnosis as well as appropriate long-term antibiotic therapy. All had good recovery at 6 months after completion of treatment.

Matched MeSH terms: Empyema, Subdural/etiology; Empyema, Subdural/microbiology; Empyema, Subdural/pathology
Fulltext Empyema thoracis presented as giant back abscess

Abd Karim SH, Wan Zain WZ, Mohd Hashim MN, Zakaria AD, Hayati F, Ng CY

Radiol Case Rep, 2021 May;16(5):1061-1064.
PMID: 33680277 DOI: 10.1016/j.radcr.2021.02.030

Empyema thoracis (ET) is defined as pus in the pleural space, either localized or involving the entire pleural cavity, due to diverse etiologies. In severe form, it may infiltrate the extrapulmonary region. Clinical guideline describes 3 stages of parapneumonic effusion before developing into an ET, namely the exudative stage, the fibrinopurulent stage, and the organizing/late stage. We highlight a 59-year-old gentleman who presented a back swelling masquerading as a deep-seated abscess, in which the diagnosis of ET had not been established early. The principles of treatment are treating the underlying condition such as pneumonia, pleural drainage and debridement, full re-expansion of the collapsed lung by performing chest physiotherapy, and improving nutrition. ET is a condition with a dynamic process due to diverse etiologies, either localized or involving the entire pleural cavity. The gold standard in diagnosing ET is the pleural aspiration of fluid from the pleural space, whereas the management of ET may include non-surgical and/or surgical treatments based on the basic principles of ET treatment.

Matched MeSH terms: Empyema, Pleural
Fulltext Inadvertent diaphragmatic rent following thoracic surgery for empyema thoracis successfully repaired with mesh

Henry Tan Chor Lip, Tan Jih Huei, Simon Jerome Vendargon

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):322-324.
MyJurnal

Iatrogenic diaphragmatic entry following thoracic surgery is rare with only two cases reported till date. This case reports on a 46-year-old male with persistent pleural sepsis due to right empyema thoracis despite best medical ef- forts. Following a right thoracotomy and decortication, the right diaphragm was inadvertently incised due to dense adhesions between the diaphragm and thickened cortex. To our knowledge, this is the third case reported of iatro- genic diaphragmatic entry following thoracic surgery for empyema thoracis. The pearls from this case report is that any evidence of empyema thoracis involving the lower lobe on imaging should warn the surgeons to be aware of inadvertent entry into the peritoneal cavity, as the diaphragm can be adherent to the cortex trapping the lower lobe.

Matched MeSH terms: Empyema, Pleural
Fulltext Low dose intrapleural alteplase and pulmozyme (DNase) in two post-surgical patients with pleural sepsis

Faisal M, Fazlin M, Ng BH, Nuratiqah N, Andrea YB

Respir Med Case Rep, 2020;30:101111.
PMID: 32518748 DOI: 10.1016/j.rmcr.2020.101111

Alteplase and pulmozyme (DNase) administered intrapleurally have revolutionised the management of pleural infection in the last decade. However, the use of intrapleural fibrinolytic has not been well established in high risks patients. Here, we describe 2 patients with high risk of bleeding due to recent surgery who developed empyema; successfully treated with these medications. The first patient was a 36-year-old female post oesophagectomy for oesophageal carcinoma, complicated with anastomotic leak and empyema; and the second patient was a 56-year-old female post percutaneous nephrolithotomy for right obstructive uropathy who developed right-sided empyema. Both patients were treated successfully with 3 doses of intrapleural alteplase 2.5 mg and DNase 5 mg without any major adverse effects. This case report adds to the current literature on the safety of intrapleural fibrinolytics and highlights that lower doses of alteplase in combination with pulmozyme is efficacious and may be considered in high-risk patients.

Matched MeSH terms: Empyema
Fulltext Spontaneous oesophageal perforation: a case report

Shu Ann Hon, Jan Jan Chai, Lian Thai Lee, Qin Jian Low

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):326-328.
MyJurnal

A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesoph- agogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.

Matched MeSH terms: Empyema, Pleural
Fulltext Invasive Pneumococcal Pneumonia with Massive Empyema: a case report

Tin Nwe Latt

Journal of Clinical and Health Sciences, 2016;1:41-47.

Although the use of appropriate antibiotics has significantly improved the outcome of pneumonia, severe complications are still encountered. We report here of a case with invasive pneumococcal pneumonia with massive empyema. A 2-year-4-month old girl presented with fever for 8 days and intermittent cough for 2 weeks. On examination, reduced air entry with dullness on percussion was noted on the left lung. Chest ultrasound revealed moderate to gross pleural effusion with septations, for which left thoraco-centesis with insertion of pigtail tube was performed. Streptococcus pneumoniae was detected via polymerase chain reaction (PCR) test in the pleural fluid. Intravenous (IV) benzylpenicillin and ceftriaxone were given together with one course (5 days) of intrapleural urokinase to breakdown the septations. Timely and appropriate management of pneumonia including the use of thrombolytic agent is vital to ensure optimal outcome and reduce the need of invasive procedures in cases with massive empyema. Public awareness of pneumococcal vaccination is also essential as a part of preventive measures.

Matched MeSH terms: Empyema
Fulltext Orbital Cellulitis Secondary to Dental Abscess in Children

Abdul Satar H, Yaakub A, Md Shukri N, Ahmad Tajudin LS

Cureus, 2021 Apr 09;13(4):e14392.
PMID: 33981511 DOI: 10.7759/cureus.14392

Paediatric orbital cellulitis is a potential sight- and life-threatening condition. It is a serious infection in children that can result in significant complications, including blindness, cavernous sinus thrombosis, cerebral venous sinus thrombosis, meningitis, subdural empyema, and brain abscess. Of the patients with orbital cellulitis, 17% died from meningitis, and 20% of the survivors had permanent loss of vision. Therefore, the potential for sight- and life-threatening complications makes prompt diagnosis and early treatment very important. We report here a case of a two-year-old girl who presented with a three-day history of left periorbital swelling, preceded by left upper perioral swelling that extended upward to the left cheek and left lower lid and was associated with low-grade fever. The patient had been admitted and was treated as having left preseptal with facial cellulitis; the patient was started on intravenous amoxicillin/clavulanic acid (200 mg three times per day dose), and chloramphenicol ointment was applied to the periorbital area. On day 3, the condition worsened, and dental examination showed multiple dental caries, upper gum swelling and abscess, and mobility of teeth 61 and 62 (two baby teeth). Contrast-enhanced computed tomography (CECT) of the orbit, paranasal, and brain showed a left periosteal abscess collection extending to the inferomedial region of the orbit. Examination and tooth extraction were performed under general anesthesia. The intraoperative results showed the presence of a left upper gum abscess, which was possibly the primary source of infection. Clinical improvement was observed postoperatively. Orbital cellulitis can be a complication of a dental abscess. This case emphasizes the importance of primary tooth care in children. A lack of care can result in fatal complications.

Matched MeSH terms: Empyema, Subdural
Fulltext Atypical Pelvic Inflammatory Disease (PID) with Empyema and Ascites in A Single Unmarried Lady

Roszaman Ramli, Mokhtar Awang, Ghazali Ismail

International Medical Journal Malaysia, 2006;5(2):1-7.
MyJurnal

Pelvic inflammatory disease (PID) is a common cause of morbidity and accounts for 1 in 60 GP consultations by women under the age of 45 in the UK. Pelvic inflammatory disease encompases a broad category of disease including endometritis, salphingitis, salphingo-oopheritis, tuboovarian abscess and pelvic peritonitis. It most commonly occurs as a result of Chlamydia trachomatis or Nesseria gonorrhea 1,2 infection of the endocervix that eventually spread into the upper genital tract. Direct spread from a nearby infection such as appendicitis and diverticulitis is not that common. Hematogenous spread is rare except in cases of tuberculous pelvic inflammatory disease. This case illustrates atypical presentation of pelvic inflammatory disease in a previously healthy single unmarried lady. The presence of ascites, bilateral ovarian mass and constitutional symptoms closely mimics that of malignant ovarian tumour. This was preceded by empyema which grew E coli.

Matched MeSH terms: Empyema
Fulltext Invasive Pneumococcal Pneumonia with Massive Empyema: a case report

Tin Nwe Latt

Journal of Clinical and Health Sciences, 2016;1(2):41-47.
MyJurnal

Although the use of appropriate antibiotics has significantly improved the outcome of pneumonia, severe complications are still encountered. We report here of a case with invasive pneumococcal pneumonia with massive empyema. A 2-year-4-month old girl presented with fever for 8 days and intermittent cough for 2 weeks. On examination, reduced air entry with dullness on percussion was noted on the left lung. Chest ultrasound revealed moderate to gross pleural effusion with septations, for which left thoraco-centesis with insertion of pigtail tube was performed. Streptococcus pneumoniae was detected via polymerase chain reaction (PCR) test in the pleural fluid. Intravenous (IV) benzylpenicillin and ceftriaxone were given together with one course (5 days) of intrapleural urokinase to breakdown the septations. Timely and appropriate management of pneumonia including the use of thrombolytic agent is vital to ensure optimal outcome and reduce the need of invasive procedures in cases with massive empyema. Public awareness of pneumococcal vaccination is also essential as a part of preventive measures.

Matched MeSH terms: Empyema

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