Ambulatory drainage and management of a pleural empyema

A 61 year old male presented to chest clinic with a lung abscess. This ruptured and resulted in an empyema that required a small bore chest drain. Pus started bypassing the drain, spilling out subcutaneously. This was probably due to the impending formation of an empyema necessitans. To stem the flow, a large bore drain was inserted. An ambulatory bag was connected to the end of that drain which enabled outpatient management through the ambulatory care unit over a ten week period. The chest drain stayed in for nine weeks. Risk stratification using the RAPID score was applied. This is a routine medical presentation with well-known and accepted investigations with routine organisms (mixed aerobic and anaerobic microbiota) and treatment with classical broad spectrum antibiotics. The striking feature of the case is that with strict supervision, patient education and motivation, ambulatory management is perfectly feasible and safe.