[Late-onset postpneumonectomy empyema]

Empyema occurring after pneumonectomy is a major complication usually diagnosed during the same hospitalization. However, late-onset empyemas are not infrequent and may be difficult to diagnose and manage.

From 1995 to 2008, 15 patients were referred to our department for an empyema that occurred between four months and 16years following a pneumonectomy (mean is equal to four years). We more particularly reviewed the mode of occurrence, the possible causes and the management of those late infections.

Presentation and characteristics were miscellaneous and delay in diagnosis was generally the rule. Two tendencies were emerging according to the delay of occurrence. During the first year following the pneumonectomy, the patients (n=8) had often received an adjuvant treatment (radiation therapy: n=2; radiation and chemotherapy: n=1; chemotherapy: n=2), often presented a bronchial fistula (n=5), and post-management morbidity (two deaths). After the first year, the patients (n=7) were without bronchial fistula, had rarely received an adjuvant therapy (n=1), and were rather suffering multiple associated diseases (n=3), or a bacteremia (n=3), and the treatments were more rapidly efficient.

Empyema is among the first diagnoses to think about in case of fever occurring late after pneumonectomy. Early diagnosis may permit more rapid management and hence, easier and better recovery.