Thorac Cardiovasc Surg 2003; 51(6): 338-341
DOI: 10.1055/s-2003-45421
Original Thoracic
© Georg Thieme Verlag Stuttgart · New York

Treatment of Post-pneumonic Empyema Thoracis

K.  Athanassiadi1 , M.  Gerazounis2 , N.  Kalantzi2
  • 1Departments of Thoracic Surgery, “Sotiria” General Hospital for Chest Diseases and
  • 2Departments of Thoracic Surgery, General Hospital of Piraeus, Athens, Greece
Further Information

Publication History

Received August 27, 2003

Publication Date:
11 December 2003 (online)

Abstract

Objective: The present study evaluates the management of 65 consecutive patients with post-pneumonic empyema thoracis (PET) treated in our department during the last ten years. Materials: There were 51 male (78.5 %) and 14 female (21.5 %) aged 23 - 82 years. The initial cause of PET was pneumonia (postoperative and posttraumatic empyemas were excluded). In 2 cases, a bronchopleural fistula coexisted. Diagnosis was based on clinical, radiological and pleural fluid culture findings. Pneumonococci and staphylococci were the predominant bacterial isolates in our series. Results: Tube thoracostomy drainage (TS) was performed in all our patients. Forty-nine patients (75.4 %) were successfully treated with TS alone. The other 16 patients were submitted to thoracotomy: lung decortication (n = 14) along with segmentectomy in two cases and the Eloesser procedure, also in two cases. The mortality rate reached 9.2 % (n = 6). Septic shock, multiple organ failure, cardiac insufficiency, and end-stage renal failure were the causes. Conclusions: 1. Complete drainage and full lung expansion by tube thoracostomy with suction are essential in the management of post-pneumonic empyema thoracis. Surgery should only be carried out right away if these conditions are not achieved. 2. Despite clinical experience and the major strategies and procedures available, the mortality remains high.

References

  • 1 Hippocrates .Genuine works of Hippocrates. Translated by Anderer F. London: Sydenham Society 1847
  • 2 Pothula V, Krellenstein D J. Early aggressive surgical management of parapneumonic empyemas.  Chest. 1994;  105 (3) 832-836
  • 3 Lindskog G E. Dramatic decline in the incidence of empyema.  N Engl J Med. 1956;  255 310-315
  • 4 Hoover E L, Hsu H K, Ross M J, Gross A M, Webb H, Ketosugbo A, Finch P. Reappraisal of empyema thoracis; Surgical intervention when the duration of illness is unknown.  Chest. 1986;  90 (4) 511-515
  • 5 Muskett A, Burton N A, Karwande S V, Collins M P. Management of refractory empyema with early decortication.  Am J Surg. 1988;  156 529-532
  • 6 Ali I, Unruh H. Management of empyema thoracis.  Ann Thorac Surg. 1990;  50 355-359
  • 7 Mavroudis C, Symmonds J B, Minagi H, Thomas A N. Improved survival in management of empyema thoracis.  J Thorac Cardiovasc Surg. 1981;  82 49-57
  • 8 Smith J A, Mullerworth M H, Westlake G W, Tatoulis J. Empyema Thoracis: 14-year experience in a teaching center.  Ann Thorac Surg. 1991;  51 39-41
  • 9 Cham C W, Haq S M, Rahamim J. Empyema thoracis: a problem with late referral?.  Thorax. 1993;  48 925-927
  • 10 Ashbaugh D C. Empyema thoracis. Factors influencing morbidity and mortality.  Chest. 1991;  99 (5) 1162-1165
  • 11 Kelly C J, Morris M J. Empyema thoracic: Medical aspects of evaluation and treatment.  South Med J. 1994;  87 (11) 1103-1110
  • 12 Mandal A K, Thadepalli H, Mandal A K, Chettipally U. Outcome of primary empyema thoracis: Therapeutic and Microbiologic aspects.  Ann Thorac Surg. 1998;  66 1782-1176
  • 13 Neff C C, von Sonnenberg E, Lawson D W, Saton A S. CT follow up of empyemas : pleural peels resolve after percutaneous catheter drainage.  Radiology. 1990;  176 195-197
  • 14 Temes R Th, Follis F, Kessler R M, Pert S B, Wernly J A. Intrapleural fibrinolytics in management of empyema thoracis.  Chest. 1996;  110 (1) 102-105
  • 15 Lawrence D R, Ohri S K, Moxon R E, Townsend E R, Fountain S W. Thoracoscopic debridement of empyema thoracis.  Ann Thorac Surg. 1997;  64 1448-1150
  • 16 Huertgen M, Witte B, Friedel G, Toomes H. Der videoassistiert-thorakoskopische Zugang zum Pleuraempyem im Vergleich zu Drainagetherapie oder Thorakotomie.  Chirurg. 1999;  70 464-468
  • 17 Barett N R. The treatment of acute empyema.  Ann R Coll Surg Engl. 1954;  15 25-33
  • 18 Mouroux J, Riquet M, Padovani B, Debesse B, Richelme H. Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: indications and results.  Br J Surg. 1995;  82 39-43
  • 19 LeMense G P, Strange C h, Sahn S A. Empyema Thoracis: Therapeutic management and outcome.  Chest. 1995;  1076 1532-1535

MD Kalliopi Athanassiadi

“Sotiria” General Hospital for Chest Diseases

34A Konstantinoupoleos str.

Holargos, Athens

Greece

Phone: +30/210/51 03 88

Fax: +30/210/654 76 95

Email: kallatha@otenet.gr

    >