Schachter E N, Kreisman H, Putman C
Arch Intern Med. 1976 Feb;136(2):167-71.
Eleven of 48 (23%) patients diagnosed as having lung abscess or empyema presented diagnostic problems in the localization of infected material. All 11 patients were found eventually to have empyemas, all but one of which was complicated by bronchopleural fistulas. Difficulty in distinguishing abscess from empyema on a chest roentgenogram delayed diagnostic and therapeutic thoracentesis from 1 to 12 days. Pleural effusions were noted in all but one of the patients who did not initially have a bronchopleural fistula. In addition, once the bronchopleural fistula became established, the extension of the air-fluid level to the chest wall, the tapered borders of the air-fluid pocket, and the extension of the lesion across fissure lines were noted, in retrospect, to be suggestive of pleural localization. Delay in the evacuation of empyema fluid can lead to chronic complications and increased morbidity. Early identification and treatment of pleural effusions may avoid these diagnostic and therapeutic problems.
48例被诊断为肺脓肿或脓胸的患者中，有11例（23%）在感染物质定位方面存在诊断问题。最终发现这11例患者均为脓胸，除1例之外，其余均合并支气管胸膜瘘。胸部X线片上难以区分脓肿与脓胸，导致诊断性和治疗性胸腔穿刺延迟1至12天。最初没有支气管胸膜瘘的患者中，除1例之外，其余患者均发现有胸腔积液。此外，一旦形成支气管胸膜瘘，回顾性观察发现，气液平面延伸至胸壁、气液腔的锥形边界以及病变跨越裂隙线的延伸，提示为胸膜定位。脓胸积液引流延迟可导致慢性并发症并增加发病率。早期识别和治疗胸腔积液可避免这些诊断和治疗问题。
