Management of Thoracic Empyema: Review of 112 Cases
To review our experience in treatment of patients with thoracic empyema at a teaching hospital chart of patients were retrospectively reviewed over a 72-month period. A total of 112 patients (94 men, 18 women, mean age: 39, range: 6-89 years) underwent therapeutic procedures for thoracic empyema between 2001-2006. The causes of empyema included parapneumonic empyema (60.7%), thoracic trauma (20.5%), surgical procedures (7.1%) and seeding from an extra-pulmonary source (11.7%). Multiloculated empyemas were documented in 45 patients (40%). Insertion of chest tube was the first procedure in 103 patients (92%). Nineteen patients (17%) were treated by thoracotomy, ten patients (8.9%) had fibrinolytic therapy, eight patients (7.2%) underwent video assisted thoracic surgery (VATS) and sixteen patients (14.3%) had subsequent radiologic-guided drainage. Thoracotomy-Decortication was successful in 90% of patients undergoing surgery and the least successful intervention was tube thoracostomy alone. Twelve of 112 patients (10.7%) died in the hospital including one patient in the thoracotomy group. Long-term follow-up was available in 67 patients including all of patients requiring surgery and fibrinolytic therapy. Thirty four patients (50%) obtained complete functional recovery. Simple drainage as the first procedure for the treatment of thoracic empyema has a high failure rate. Selection of a therapeutic option should be based on age, underlying disease, stage of the empyema, state of the loculation, local expertise and availability. Surgical procedures such as VATS or thoracotomy are recommended as the first procedure in elderly patients and advanced empyema.
LeMense GP, Strange C, Sahn SA. Empyema thoracis. Therapeutic management and outcome. Chest 1995;107(6):1532-7.
Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn S, Weinstein RA, Yusen RD. Medical and surgical treatment of parapneumonic effusions: an evidence-based guideline. Chest 2000;118(4):1158-71.
Miller JI. Postsurgical empyema. In: Shields TW, Locicero J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins;2005. p. 833.
McLaughlin JS, Krasna MJ. Parapneumonicempyema. In: Shields TW, Locicero J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2005. p. 819.
Heidecker JT, Sahn SA. Intrapleuralfibrinolytics. In: Ferguson MK, editor. Difficult Decisions in Thoracic Surgery: An Evidence-based Approach. London: Springer- Verlag;2007. p. 433-8.
Wozniak CJ, Paull DE, Moezzi JE, Scott RP, Anstadt MP, York VV, Little AG. Choice of first intervention is related to outcomes in the management of empyema. Ann ThoracSurg 2009;87(5):1525-30; discussion 1530-1.
Hampson C, Lemos JA, Klein JS. Diagnosis and management of parapneumonic effusions. SeminRespirCrit Care Med 2008;29(4):414-26.
Crouch JD, Keagy BA, Delany DJ. "Pigtail" catheter drainage in thoracic surgery. Am Rev Respir Dis 1987;136(1):174-5.
Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2008;(2):CD002312.
Casali C, Storelli ES, Di Prima E, Morandi U. Long-termfunctional results after surgical treatment of parapneumonic thoracic empyema. Interact CardiovascThoracSurg 2009;9(1):74-8.
Hsieh MJ, Liu YH, Chao YK, Lu MS, Liu HP, Wu YC, Lu HI, Chu Y. Risk factors in surgical management of thoracic empyema in elderly patients. ANZ J Surg 2008;78(6):445-8.
Molnar TF. Current surgical treatment of thoracic empyema in adults. Eur J CardiothoracSurg 2007;32(3):422-30.
Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, Gabe R, Rees GL, Peto TE, Woodhead MA, Lane DJ, Darbyshire JH, Davies RJ; First Multicenter Intrapleural Sepsis Trial (MIST1) Group. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005;352(9):865-74.
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