CLASSIFICATION OF PARAPNEUMONIC EFFUSION
EMPYEMA LIGHT'S CLASSIFICATION - BASED ON
1) AMOUNT OF FLUID
2) GROSS CHARACTERISTICS OF PLEURAL FLUID
3) BIOCHEMICAL CHARACTERISTICS OF PLEURAL FLUID
4) LOCULATIONS
CLASS 1
– NON SIGNIFICANT PARAPNEUMONIC EFFUSION
•
Free flowing fluid
•
Less than 10mm on lateral decubitus chest
radiograph
•
Treatment – antibiotics
CLASS 2
– TYPICAL PARAPNEUMONIC EFFUSION
•
Pleural fluid is free flowing
•
Thickness >10 mm
•
Pleural fluid Glucose > 40mg/dl
pH > 7.20
LDH < 3times the upper limit normal for serum
•
Bacterial smear and culture – negative
•
Rx – antibiotics alone
CLASS 3
– BORDERLINE COMPLICATED PARAPNEUMONIC EFFUSION
•
Bacterial smear and culture – negative
•
Glucose > 40mg/dl
•
pH between 7.00 to 7.20
•
LDH > 3 times the upper limit normal for
serum (or)
•
Pleural fluid is loculated
•
Rx – antibiotics + serial thoracentesis
CLASS 4
– SIMPLE COMPLICATED PARAPNEUMONIC EFFUSION
•
Ph < 7.00
•
Glucose < 40mg/dl
•
LDH > 3 times the upper limit normal for
serum
•
Positive gram stain or culture
•
Fluid does not look like pus and it is not
loculated
•
Rx – tube thoracostomy + antibiotics
CLASS 5 – COMPLEX COMPLICATED PARAPNEUMONIC
EFFUSION
•
class 4 + Loculations
•
Tube
thoracostomy + fibrinolytics (or) thoracotomy with decortication (rarely)
CLASS 6 – SIMPLE EMPYEMA
•
Frank pus – either
free flowing or single loculus
•
Have
a thick peel over the visceral fluid that prevents the underlying lung from
expanding
•
Rx – tube thoracostomy + decortication
•
If empyema cavity remains after several days of
chest tube drainage - then decortication is considered
CLASS 7
– COMPLEX EMPYEMA
•
Frank pus – multiloculated
•
Initially – tube thoracostomy +
fibrinolytics
•
Often
requires – thoracoscopy with breakdown of adhesions or thoracotomy and
decortication
