CT follow-up of empyemas: pleural peels resolve after percutaneous catheter drainage

In this prospective study, computed tomography (CT) was used to examine the resolution of pleural abnormalities following radiologic catheter drainage of empyemas. Ten patients with empyemas surrounded by pleural peels underwent thoracic CT scanning at 4, 8, and 12 weeks after removal of their catheter(s). The scans demonstrated extensive pleural thickening 4 weeks after catheter removal in all 10 patients. The pleural thickening had decreased 8 weeks after catheter removal. At 12 weeks, the pleura was essentially normal in four patients, demonstrated only a small area of plaque-like thickening in four patients, and was mildly thickened in two patients. This study demonstrates that the pleural surfaces have a remarkable capacity for healing after empyema drainage. The pleural peel resolves in most cases. These results suggest that decortication need not be performed routinely when such empyemas are encountered; rather, patients should be treated on an individualized basis and studied with serial CT to determine the necessity of decortication.