Minimally Invasive Treatment of Thoracic Empyema

Abstract

Background: The present study was undertaken to assess the efficacy of serial thoracocentesis and saline irrigation for the treatment of pleural empyema, for post-pneumonia versus other causes. Methods: Included were 42 consecutive patients with complicated pleural effusion (n = 14) or frank pus (n = 28) at diagnostic thoracocentesis, of mean age 57.5 ±23.7 years. Pneumonia was the probable cause in 29 patients, other causes (principally thoracic surgery) in 13. In addition to antibiotics in all patients, ultrasonography-guided serial suction thoracocentesis with saline irrigation was used as therapy of first choice in most patients: 28/29 post-pneumonia and 9/13 non-pneumonic empyema. Exceptions were mainly on the grounds of preceding thoracic surgery. Results: Success rate was 86% in the post-pneumo nia group, with no crossovers to more invasive therapy. Mor tality was 14%, none empyema-related. Treatment was less successful in the non-pneumonia group at 69%, with a 56% crossover rate from thoracocentesis due to therapy failure. Mortality was 23 %. Conclusions: Results indicate that timely, minimally invasive therapy is a feasible modality for the management of post-pneumonia thoracic empyema. Serial thoracocentesis was less suitable for the treatment of non-pneumonic empyema, however, particularly if it was a surgical complication. More invasive strategies seem preferable in such cases.

Key words

Pleural empyema - Irrigation - Pneumonia - Pleural effusion - Thoracocentesis