Malattie dell'apparato respiratorio - il versamento pleurico parapneumotico

Versamento parapneumonico

Light’s classification of parapneumonic effusion and empyema

Class 1: Non significant pleural effusion

• Small, < 10mm thick on rx-ll
• No toracentesis indicated

Class 2: Typical parapneumonic pleural effusion

• > 10 mm thick
• Glucosio > 40
• pH > 7.20
• LDH > 3 x upper limit normal for serum
• Gram’s stain and culture negative
• Antibiotics alone

Class 3: Borderline complicated pleural effusion

• Glucosio > 40
• pH 7.00 - 7.20
• LDH > 3 x upper limit normal for serum
• Gram’s stain and culture negative
• Antibiotics + serial toracentesis

Class 4: Simple complicated pleural effusion

• Not loculated – not frank pus
• Glucosio < 40
• pH < 7.00
• LDH > 3 x upper limit normal for serum
• Gram’s stain and culture positive
• Antibiotics + tube toracostomy

Class 5: Complex complicated pleural effusion

• Loculated – not frank pus
• Glucosio < 40
• pH < 7.00
• LDH > 3 x upper limit normal for serum
• Gram’s stain and culture positive
• Tube toracostomy + fibrinolytics
• “... rarely require thoracoscopy or decortication ...”

Class 6: Simple empyema

• Frank pus present (single locule or free flowing)
• Tube toracostomy and (decortication)

Class 7: Complex empyema

• Frank pus present (multiple locules)
• Tube toracostomy + fibrinolytics
• “... often require thoracoscopy or decortication ...”

Versamento pleurico parapneumonico complesso o empiema pleurico complesso (classe V e VII)

Utilità della toracoscopia

• Deloculazione
• Lisi delle aderenze
• Impedire l’incarceramento polmonare
• Favorire la riespansione polmonare
• Permettere un adeguato posizionamento del tubo
• Escludere una etologia neoplastica (2-4%)