We report here our 13-year experience treating chronic
tuberculous empyema by open window
thoracostomy. The subjects were 33 patients (28 males and 5 females) with a median age of 70 (range: 56-83) years who underwent surgery between January 1990 and December 2002. Patients with a history of pulmonary resection or
thoracoplasty were excluded. All patients complained of
cough and purulent sputum related to the presence of bronchopleural
fistula. Previous illnesses included
pulmonary tuberculosis (n = 20) and
tuberculous pleurisy (n = 14) treated by
artificial pneumothorax (n = 1) or
chemotherapy (n = 22). Median duration from the initial episode of
tuberculosis to surgery was 44 (range: 1-60) years. Mycobacterium tuberculosis (n = 9), Aspergillus fumigatus (n = 6), methicillin-resistant Staphylococcus aureus (MRSA) [n = 5], and Pseudomonas aeruginosa (n = 5) were representative microorganisms isolated from
empyema. Preoperative mean %VC was 48 (range: 31-74)%. Mean follow-up was 34 (range: 1-131) months. Seven patients died of
empyema-related disease within 6 months postoperatively. Nine patients underwent curative surgery to close the
thoracostomy, including extrapleural
pneumonectomy (n = 5), muscular transposition with
thoracoplasty (n = 3), and lobectomy with muscular transposition and
thoracoplasty (n = 1). In 17 patients, the
thoracostomy was left open throughout the observation period because of severe impairment of pulmonary function. In elderly patients with severely impairment of pulmonary function, open window
thoracostomy does not control
empyema well and has a high rate of mortality.