Aim: The aim of this work is to study the efficacy and safety of medical thoracoscopy in management of empyema. Patients and methods: This study included 30 inpatients with empyema. Included patients had frank pus on thoracocentesis (turbid malodorous liquid) with or without positive Gram stain smear and bacteriologic culture findings or pH < 7.20, with signs of infection. Patients were managed by medical thoracoscopy. Medical thoracoscopy using rigid thoracoscopy was used to drain fluid, visualize pleural cavity, assess for adhesions and purulent material, cutting of adhesions, irrigation by normal saline with partial depeeling and debridement of accessible parietal pleurae. Results: The present study included 30 patients with empyema (17 male, 13 female with mean age47.4±14.5years, range: 18-70 years), 19 patients (63.3%) had free flowing empyema (by CT/US), and 11 patients (36.7%) had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess and cause was not identified in 9 patients (primary pleural infection) (30%). Medical thoracoscopy was successful in all patients with free-flowing empyema, in 63.6% of patients with multiloculated empyema. 4 patients (13.3%) received eventual surgical intervention (surgical decortication). No deaths or chronic morbidity related to empyema were observed. Conclusion: Medical thoracoscopy is a simple, safe, minimally invasive and effective modality in management of empyema. |
