[Treatment of pleural empyema].

Abstract

Pleural empyema remains a frequently encountered clinical problem and is responsible for significant morbidity and mortality worldwide. Its diagnosis may be difficult; delays in diagnosis and treatment may contribute to morbidity, complications, and mortality. The management of parapneumonic effusion and empyema depends on timely, stage-dependent therapy and the underlying etiology. Thoracentesis and antibiotics remain the cornerstones of treatment in stage I disease. In the early fibrinopurulent phase (stage II) thoracoscopic methods should be considered. As treatment strategy for this stage, fibrinopurulent pleural empyema entails thorough debridement of multiloculated collections from the pleural cavity by video-assisted thoracic surgery. After evacuation of multilocular effusions and the removal of fibrin deposits with drainage by two intercostal chest tubes, irrigation treatment helps to achieve clarity of the pleural discharge. Open thoracotomy and decortication are reserved for organized, multiloculated empyema with lung entrapment (stage III disease). Early drain removal may lead to rapid symptomatic recovery and complete resolution.

• Authors: M Klopp, J Pfannschmidt, H Dienemann
• Journal: Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen (Chirurg) Vol. 79 Issue 1 Pg. 83-94; quiz 95-6 (Jan 2008) ISSN: 0009-4722 [Print] Germany
• Vernacular Title: Behandlung des Pleuraempyems.
• PMID: 18209983 (Publication Type: Comparative Study, Journal Article, Review)

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Aged
• Algorithms
• Anti-Bacterial Agents (therapeutic use)
• Debridement
• Drainage
• Empyema, Pleural (classification, diagnosis, diagnostic imaging, drug therapy, etiology, surgery, therapy)
• Female
• Fluoroscopy
• Humans
• Male
• Middle Aged
• Radiography, Thoracic
• Thoracic Surgery, Video-Assisted
• Thoracoscopy
• Thoracostomy
• Thoracotomy
• Tomography, X-Ray Computed