الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
 |  | from | 106 |  |  |
| | | from | 106 | | |
Abstract
Hepatic hydrothorax is defined as a significant pleural effusion, usually greater than 500 ml, in a cirrhotic patient without any underlying pulmonary or cardiac diseases.
Spontaneous bacterial empyema (SBEM) is defined as pleural fluid with a polymorphonuclear (PMN) cell count > 500 cells/mm3 or positive culture with PMN cell count > 250 cells/mm3with the exclusion of a parapneumonic effusion.
The aim of this study was to determine:
1- The frequency of SBEM in patients with hepatic hydrothorax.
2- The causative organisms of SBEM.
The study included 100 patients with hepatic hydrothorax with or without ascites divided into two groups after thoracocentesis for pleural fluid culture:
1- group 1 (uncomplicated hydrothorax): included 85(85%) patients with uncomplicated hydrothorax(49 males and 36 females).
2- group 2 (SBEM): included 15(15%) patients withspontaneous bacterial empyema (10 males and 5 females).
In uncomplicated hydrothoraxgroup, age ranged from 48-65 years with a mean ±SD (57.84±5.20), while in group (SBEM), age ranged from 45-63 years with a mean ±SD (56.40±5.62).
The studied patients were subjected to complete history, physical and abdominal ultrasonographic examinations, chest x-ray, chest sonar and laboratory investigations (Complete Blood Count, ALT, AST, serum albumin, serum bilirubin and prothrombin time and concentration).
Pleural fluid analysis (pleural fluid PH, glucose, polymorphonuclear(PMN) cell count, protein, differential cytology, gram staining, and culture by conventional and modified methods (inoculation of 10 mL of pleural fluid into a blood culture bottle.
Diagnostic criteria for SBEM included positive pleural fluid culture and a PMN count of[>250 cells/mm3or, if a negative culture, a pleural fluid PMN count of [>500 cells/mm3and the absence of pneumonia on chest radiography. Fifteen (15%) of 100 patients showed the criteria of SBEM.
Regarding liver functions test, there were no significant statistical difference between SBEM and uncomplicated hydrothoraxgroup as regard liver enzymes [ALT and AST], serum bilirubin and protrombin time and concentration but patients with SBEM showed more reduced serum albumin than those with sterile pleural effusion.
As regard abdominal USand chest sonar, in 15 patients with SBEM only one patient presented without ascites while in 85 patients with uncomplicated hydrothorax two patients presented without ascites.
Regarding chest x-ray, in 15 patients with SBEM only one patient presented with left sided pleural effusion while in in 85 patients with uncomplicated hydrothorax10 patients presented with left sided pleural effusion and only 2 patients with bilateral pleural effusion.
Pleural fluid culture was positive bythe conventional method in 4 (26.6%) patients and by the modified method in 12 (80%) patients. The microorganisms identified in pleural fluid wereEscherichia coli in 7 (58.3%) patients, Streptococci in 2 (16.7%) patients, Klebsiella in 2 (16.7%) patients and Pseudomonas in one (8.3%) patient.