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Role of medical Thoracoscopy in the Management of Multiloculated Empyema

Kamran Khan Sumalani1, Nadeem Ahmed Rizvi2, Asif Asghar3

  • 1Department of Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi, 75400, Pakistan. drkamrankn@hotmail.com.

BMC Pulmonary Medicine
|November 30, 2018
PubMed
Abstract

Insights

Rigid medical thoracoscopy under local anesthesia effectively manages complicated pleural empyema by enabling adhesion removal. This safe and efficient procedure offers a cost-effective solution, especially in resource-limited environments.

Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Medical Interventions

Background:

  • Early pleural empyema treatment involves antibiotics and thoracocentesis.
  • Complicated empyema requires adhesion removal for lung expansion.
  • Multiloculated, exudative, and fibrinopurulent empyema present management challenges.

Purpose of the Study:

  • To analyze the experience of managing complicated empyema using rigid medical thoracoscopy.
  • To explore novel management strategies for multiloculated empyema.
  • To evaluate the efficacy and safety of thoracoscopy under local anesthesia.

Main Methods:

  • A descriptive case series of 160 patients with complicated empyema.
  • Procedures performed between September 2014 and August 2016.
  • Rigid medical thoracoscopy conducted under local anesthesia; exclusion criteria included age >70, multiple organ failure, and bleeding disorders.

Main Results:

  • The study included 160 patients (67.5% male, 32.5% female), mean age 25.37 years.
  • Tuberculous empyema was diagnosed in 63.7% of patients.
  • Complete resolution was observed in 57.5% of patients, with 36.25% showing partial resolution. Persistent air leak occurred in 5.6%, and one patient expired.

Conclusions:

  • Medical thoracoscopy under local anesthesia is a safe and efficient intervention for complicated empyema.
  • The procedure is cost-effective, particularly in resource-constrained settings.
  • This approach facilitates lung expansion by addressing adhesions in complex empyema cases.
Keywords:
Empyema pleuralInflammationThoracoscopyTuberculosisVideo-assisted thoracoscopic surgery

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