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Optimal management of complicated empyema
A de Souza1, P J Offner, E E Moore
1Department of Surgery, Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, Colorado, USA.
American Journal of Surgery
|February 22, 2001
Summary
Empyema management is complex. While multiloculation doesn't preclude fibrinolytic therapy, chest CT evidence of a pleural peel predicts nonoperative treatment failure, guiding surgical decisions.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Diagnostic Imaging
Background:
- Empyema management remains a significant surgical challenge despite advances in medical therapy.
- Optimal therapeutic strategies for empyema are not yet fully established.
Purpose of the Study:
- To evaluate treatment outcomes for empyema.
- To identify predictors of treatment failure in empyema patients.
Main Methods:
- Retrospective review of 58 adult empyema patients admitted between 1993 and 1998.
- Data collected included demographics, presentation, chest CT findings, treatment modalities, and patient outcomes.
Main Results:
- 45 of 58 empyema cases were multiloculated; 41 were secondary to pneumonia, 15 posttraumatic.
- Intrapleural fibrinolytic therapy failed in 45% of patients.
- Chest CT evidence of a pleural peel uniformly predicted failure of nonoperative treatment, though CT missed peels in 17/31 patients.
Conclusions:
- Multiloculation does not contraindicate initial chest tube drainage or fibrinolytic therapy for empyema.
- Chest CT findings of a pleural peel are a strong predictor of nonoperative treatment failure.
- These findings can help guide therapeutic decisions in empyema management.