Background Empyema thoracis is defined as accumulation
of pus in the pleural space. Despite advanced medical
diagnostic and therapeutic methods, thoracic empyema
remains a common clinical entity and a serious problem all
over the world with significant associated morbidity and
mortality.
Aim The aim of this work was to study the efficacy and safety
of medical thoracoscopy (MT) in the management of
empyema.
Patients and methods This study included 30 inpatients with
empyema. Included patients had frank pus on aspiration
(turbid purulent fetid fluid) with or without positive Gram stain
smear and microbiological culture findings or pH less than
7.20, with signs of sepsis. Patients were managed by MT. MT
using rigid thoracoscopy was performed with evacuation of
the purulent fluid, visualization of the pleural space,
assessment of adhesions and purulent material, forceps
adhesiolysis, and irrigation by normal saline with partial
debridement of accessible parietal pleural surface.
Results The present study included 30 patients with
empyema (17 men, 13 women with a mean age of 47.4±14.5
years; range, 18–70 years); 19 (63.3%) patients had freeflowing
empyema (by computed tomography/
ultrasonography) and 11 (36.7%) patients had multiloculated
empyema. The etiology of empyema included pneumonia
(parapneumonic effusion) (33.3%), malignancy (23.3%),
tuberculosis (6.7%), lung abscess (6.7%), and no cause was
identified in nine patients (spontaneous pleural infection)
(30%). MT was considered successful without subsequent
interventional procedures in 26 of 30 (86.7%) patients,
including all patients with free-flowing empyema (19 patients),
63.6% of patients with multiloculated empyema (seven
patients), and four (13.3%) patients required surgical
intervention (surgical decortication). No procedure-related
mortality or chronic morbidity occurred in this study.
Conclusion MT is a simple, safe, minimally invasive, and
effective modality in the management of empyema.
Egypt J Bronchol 2019 13:55–62
© 2019 Egyptian Journal of Bronchology |
