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Empyema thoracis: lack of awareness results in a prolonged clinical course
M W Chu1, L R Dewar, J J Burgess
1Division of Cardiovascular and Thoracic Surgery, Regina Health District, Sask.
Objective:
To assess the hypothesis that empyema thoracis (ET) is a problem often not optimally treated. Long delays in diagnosis are common, long hospital stays are typical and recovery with surgery is relatively rapid.
Design:
A chart review.
Setting:
The Regina Health District associated hospitals, a tertiary referral centre.
Patients:
The charts of 34 consecutive patients having primary respiratory tract disease and seen during the 6-year period Apr. 1, 1991, to Mar. 31, 1997, were identified.
Outcome Measures:
Patient presentation, time until diagnosis of ET, number of radiologic investigations, microbiologic features, treatment methods, postoperative course and mortality.
Results:
The mean delay in diagnosis, defined as the time of admission to the time of correct diagnosis, was 44.2 days (range from 0 to 573 days) and the mean delay until thoracic surgery referral was 47.4 days (range from 0 to 578 days). On average each patient underwent CT 10.1 times, had 2.6 percutaneous drainage procedures and 2.0 chest tube insertions. The mean time from the first percutaneous chest drainage to the date of diagnosis was 29.8 days (range from 0 to 564 days). Of the 26 patients who underwent CT, the mean time from the first CT of the chest to the date of diagnosis was 9.5 days (range from 0 to 75 days). Cultures of pleural fluid grew no organisms in 17 patients; in the remaining 17 patients cultures grew 23 different microorganisms. Of 26 patients who were referred for surgical opinion, 18 underwent decortication; 8 were not considered to be surgical candidates. Pathological examination showed 17 cases of inflammatory empyema and 1 case of mesothelioma (unrecognized clinically). The mean length of hospital stay postoperatively was 15.2 days.
Conclusions:
Early suspicion of ET facilitates its treatment, resulting in fewer investigations and shorter hospital stays. When percutaneous drainage does not eliminate pleural effusions, empyema must be considered. Recovery from surgical decortication is rapid in comparison with the typical protracted preoperative hospital course.