Surgical management of thoracic empyema

Thoracic empyema usually results from pulmonary infection or thoracic surgery. Antibiotic therapy is an essential part of the treatment, but surgical techniques to drain the pleural fluid and obliterate the empyema space often are required. A wide range of closed and open surgical techniques are available. This article reviews the various surgical options for the treatment of nontuberculous bacterial empyema secondary to pulmonary infection in the patient with a normal immune response. Emphasis is placed on a thorough understanding of the pathophysiology and natural history of empyema for selection and timing of appropriate treatment. Thoracic imaging techniques play a substantial role in the evaluation and treatment of empyema and in assessing the outcome of surgical therapy.