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Nonresolving Empyema: Is It Encysted? A Case Report

S H Hasan1, D Chowdhury, S A Haque

  • 1Dr Syeda Humaida Hasan, Consultant, Department of Neonatology, Chittagong Medical College Hospital, Chattogram, Bangladesh;

Mymensingh Medical Journal : MMJ
|December 31, 2025
PubMed

Insights

Empyema, a serious lung infection, often requires prompt treatment. This case highlights that encysted empyema may necessitate surgical intervention like thoracotomy and decortication for successful patient recovery.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Empyema progresses through distinct phases: exudative, fibrinopurulent, and organized, typically over 3-6 weeks.
  • Diagnosis commonly involves clinical symptoms, chest X-ray, and thoracentesis.
  • Standard treatment includes antibiotics, thoracentesis, and chest tube drainage, with most patients showing improvement.

Purpose of the Study:

  • To report a case of pediatric empyema that failed conservative management.
  • To emphasize the importance of identifying encysted empyema.
  • To highlight the successful surgical management of complex pediatric empyema.

Main Methods:

  • A four-year-old girl presented with persistent symptoms of right-sided empyema.
  • Initial treatment with antibiotics and chest tube drainage was unsuccessful.
  • Advanced imaging (CECT) revealed encysted empyema, leading to thoracotomy and decortication.

Main Results:

  • The patient's empyema did not respond to conservative management, indicating radiographic loculation.
  • Surgical intervention (thoracotomy and decortication) resulted in excellent recovery.
  • Post-operative care in the Pediatric Intensive Care Unit was crucial for recovery.

Conclusions:

  • Encysted empyema is a predictor of failure in conservative empyema management.
  • Timely and appropriate surgical intervention is vital for complex pediatric empyema cases.
  • Government hospitals can provide comprehensive care, including advanced diagnostics and surgery, at reduced costs.

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