Treatment of postpneumonectomy empyema

Postpneumonectomy empyema with or without (bronchopleural) fistula is an infrequent but serious, and often life-threatening complication. In 20 of our patients postpneumonectomy empyema was discovered. The time interval between original operation and discovery of the empyema varied from 9 days to 9 years. In two cases, the empyema had been found and treated initially at another hospital but not adequately, so that at the time of treatment by us the bronchopleural fistula had already been present for 8 and 19 years. In 13 cases a bronchial stump fistula was discovered. In five patients the fistula was successfully closed endoscopically with glue. In one patient closure was performed by transmediastinal stump resection, in three patients with a fistula thoracoplasty was performed. In three patients we achieved closure by transposition of pedicled muscle flaps. In one of these patients a septic condition could be mastered by performing window thoracotomy. Two patients without fistula were successfully treated with irrigation, and two further patients with thoracostomy. In one patient recovery was achieved by medication after puncture. Two patients died of sepsis and after thoracoplasty. If a fistula is present, drainage with irrigation and endoscopical glueing should be the initial treatment. This should be followed by resection of the bronchial stump. If there is no fistula or if the stump is too short thoracostomy is the treatment of choice. If it is not successful thoracoplasty has to be performed.