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Updated: Aug 12, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
[Surgical treatment of metapneumonic pleural empyema]
1Abteilung für Thorax-und Gefässchirurgie, Stadtspital Triemli, Zürich.
Insights
Metapneumonic pleural empyema treatment involves local strategies to obliterate the pleural space. Optimal surgical approach depends on the disease stage, ranging from closed thoracostomy to decortication with pulmonary resection.
Area of Science:
- Thoracic Surgery
- Pulmonology
- Infectious Diseases
Context:
- Metapneumonic pleural empyema is a serious complication of pneumonia.
- Effective management is crucial to prevent long-term morbidity.
- Treatment strategies have evolved over time, necessitating evaluation of outcomes.
Purpose:
- To evaluate the efficacy of different local treatment modalities for metapneumonic pleural empyema.
- To correlate treatment success with the stage of pleural empyema.
- To analyze patient outcomes based on surgical intervention.
Summary:
- A 13-year study treated 54 patients with metapneumonic pleural empyema.
- Outcomes varied by procedure: closed thoracostomy (3/18 cured), open drainage (12/16 cured), and decortication (37/37 cured, 13 requiring pulmonary resection).
- One patient died due to complications during open drainage for an empyema in extremis.
Impact:
- Local treatment effectively obliterates the pleural space in metapneumonic pleural empyema.
- Closed thoracostomy is suitable for the acute exudative stage.
- Open thoracotomy with rib resection is indicated for the fibrino-purulent phase.
- Decortication is optimal for the chronic organizing stage, sometimes combined with pulmonary resection.
Abstract:
During a period of 13 years 54 patients have been treated for metapneumonic pleural empyema, namely 3 children (all boys), 31 men and 20 women. One patient was admitted in extremis heavily intoxicated after unsuccessful attempt at closed drainage. He died during thoracotomy for open drainage. All the remaining 53 patients were cured, 3 out of 18 by closed thoracostomy (Bülau), 12 out of 16 by open drainage and 37 by decortication which had to be combined with pulmonary resection 13 times. Local treatment of pleural empyema is aimed at the obliteration of the pleural space. This goal can best be accomplished: in the acute exudative stage of the disease (according to the American Thoracic Society) by closed thoracotomy, in the fibrino-purulent phase by open thoracotomy with rib resection and in the chronic organizing stage by decortication.
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