[Diagnosis and therapy of pleural empyema]

21 patients with thoracic empyema were treated at this clinic over a period of 3 years. 15 patients had metapneumonic empyema, 2 empyema associated with sepsis, and 4 postsurgical empyema. In 12 patients the underlying illness was chronic disease while 9 patients were thus far in good health. The most frequent causative pathogens were staphylococci and streptococci, together with anaerobic bacteria. One patient died of the underlying disease. Three cases of metapneumonic empyema healed completely with antibiotics only. Closed chest tube drainage with small chest tube was performed 13 times and was successful 11 times with a mean drainage duration of 13 days. Six patients underwent surgery (early decortication in 4 instances, late decortication in 2). The surgical indication was in 4 instances multilocular of the empyema which inhibited chest tube drainage, imminent loss of function in 1 case and unsuccessful drainage in a case of bronchopleural fistula in 1 instance. Apart from high-dose antibiotic therapy, earliest possible drainage is of crucial importance in the treatment of thoracic empyema. Surgery should be considered only in uncomplicated empyema if drainage is impossible for technical reasons.