Abstract
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 free-flowing 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.
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References
Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc 2006; 3: 75–80.
Koegelenberg CF, Diacon AH, Bolliger CT. Parapneumonic pleural effusion and empyema. Respiration 2008; 75: 241–250.
Girdhar A, Shujaat A, Bajwa A. Management of infectious processes of the pleural space: a review. Pulm Med 2012; 2012: 816502.
Kern L, Robert J, Brutsche M. Management of parapneumonic effusion and empyema: medical thoracoscopy and surgical approach. Respiration 2011; 82: 193–196.
Neville E, Buchanan DR. Thoracoscopy for physicians; a practical guide. London: Arnold Publisher; 2005. 57–70
Kothari CR. Research methodology: methods and techniques. New Delhi: New Age International; 2004.
Rahman NM, Ali NJ, Brown G, Chapman SJ, Davies RJ, Downer NJ, et al. BTS Pleural Disease Guideline Group. Local anaesthetic thoracoscopy: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010; 65: ii54–ii60.
Loddenkemper R. Thoracoscopy – state of the art. Eur Respir J 1998; 11: 213–221.
Yim AP. Paradigm shift in empyema management. Chest 1999; 115: 611–612.
Shoukri A. Ultrasound-assisted medical thoracoscopy. Egypt J Bronchol 2015; 9: 92–95.
Ravaglia C, Gurioli C, Tomassetti S, Casoni GL, Romagnoli M, Gurioli C, et al. Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema? Respiration 2012; 84: 219–224.
Reda MA, Abou-Rayan MA, Rabie AK, El-Ganady AA. Role of Medical thoracoscopy in the management of empyema. 2014; Faculty of Medicine, Alexandria University, Alexandria.
Hewidy A, Elshafey M. Medical thoracoscopy versus intrapleural fibrinolytic therapy in complicated parapneumonic effusion and empyema. Egypt J Chest Dis Tuberc 2014; 63: 889–896.
Jiménez D, Díaz G, García-Rull S, Vidal R, Sueiro A, Light RW. Routine use of pleural fluid cultures. Are they indicated?: Limited yield, minimal impact on treatment decisions. Resp Med 2006; 100: 2048–2052.
Bhatt CY, Narender M, Kondapaka KK, Rao VS, Kumar AS, Kandi S. Role of medical thoracoscopy in the diagnosis of pleural empyema. Inflammation 2016; 4: 20.
Akhan O, Özkan O, Akinci D, Hassan A, Özmen M. Image-guided catheter drainage of infected pleural effusions. Diagn Interv Radiol 2007; 13: 204.
Reynard C, Frey JG, Tschopp JM. Thoracoscopy under local anaesthesia for the treatment of empyemas: an efficient and not invasive technique. Méd Hyg 2004; 62: 2138–2143.
Brutsche MH, Tassi GF, Györik S, Gökcimen M, Renard C, Marchetti GP, et al. Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy. Chest 2005; 128: 3303–3309.
Soler M, Wyser C, Bolliger CT, Perruchoud AP. Treatment of early parapneumonic empyema by‘ medical‘ thoracoscopy.Schweiz Med Wochenschr 1997; 127: 1748–1753.
Ohuchi M, Inoue S, Ozaki Y, Fujita T, Igarashi T, Ueda K, et al. Single-trocar thoracoscopy under local anesthesia for pleural space infection. Gen Thorac Cardiovasc Surg 2014; 62: 503–510.
Lim TK, Yim AP. Management of pleural empyema. Chest 1999; 116: 845.
Chen KY, Liaw YS, Wang HC, Luh KT, Yang PC. Sonographic septation: a useful prognostic indicator of acute thoracic empyema. J Ultrasound Med 2000; 19: 837–843.
Tassi GF, Davies RJ, Noppen M. Advanced techniques in medical thoracoscopy. Eur Respir J 2006; 28: 1051–1059.
Tassi GF, Brutsche MH, Davies RJ. Thoracoscopy for parapneumonic effusions and empyema. In: Astoul P, Tassi G, Tschopp JM. (eds). Thoracoscopy for Pulmonologists. Berlin, Heidelberg: Springer; 2014. 16. 169–178.
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El Gazzar, A.G., El-Mahdy, M.A.E., Al Mehy, G.F. et al. The role of medical thoracoscopy in the management of empyema. Egypt J Bronchol 13, 55–62 (2019). https://doi.org/10.4103/ejb.ejb_44_18
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DOI: https://doi.org/10.4103/ejb.ejb_44_18