Perspective investigations of empyema pathogenesis

Abstract

Pleural empyema is one of the most serious septic diseases. Despite favorable outcome, therapeutic and prognostic strategies in empyema are needed to be improved. Further investigation of pathology and diagnostic histological criteria of acute and chronic purulent pleural inflammation and fibrosis is a perspective research direction, as morphological characteristics are important for prognosis and the optimal treatment choice. However, complete histological examination of the lung tissue and the visceral pleura is difficult in real clinical practice, because any lung damage can cause bronchial fistula. Nevertheless, histological features of the visceral pleura and the lungs are closely related to macroscopic characteristics of the pleura. Detailed study of this relationship and the search of morphological similarity of lesions in parietal pleura, visceral pleura, and the lung in patients with empyema could improve the diagnostic value of thoracoscopy, contribute to a rapid histological diagnosis and improve therapeutic approach to empyema. Current approach to the basic mechanisms and risk factors of remodeling of the extracellular matrix in pleural fibrosis was reviewed in the article. Analysis of this process could determine new mechanisms of extracellular matrix remodeling and ways to avoid fibrosis development in the adjacent lung tissue that, in turn, could underlie staging the empyema.