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Late-onset post-pneumonectomy empyema

W F Kerr

    Thorax
    |April 1, 1977
    PubMed
    Summary
    This summary is machine-generated.

    Late-onset empyema after pneumonectomy presents diagnostic challenges, often requiring delayed intervention. Early diagnosis and open drainage are crucial for patient survival, even in complex cases with fistulae.

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    Area of Science:

    • Thoracic Surgery
    • Infectious Diseases
    • Pulmonary Medicine

    Background:

    • Empyema developing late after pneumonectomy is a rare but serious complication.
    • Diagnosis can be delayed due to non-specific symptoms and challenges in imaging interpretation.
    • The obliteration of the pneumonectomy space is often assumed, complicating understanding of late infections.

    Purpose of the Study:

    • To present nine cases of empyema occurring more than three months post-pneumonectomy.
    • To analyze diagnostic challenges, treatment outcomes, and potential etiologies.
    • To challenge the assumption of complete pneumonectomy space obliteration.

    Main Methods:

    • Retrospective review of nine patients diagnosed with late-onset empyema after pneumonectomy.

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  • Analysis of clinical presentation, diagnostic methods (including radiology), and microbiological findings.
  • Evaluation of treatment strategies, primarily open drainage, and patient outcomes.

    • Main Results:

    • Diagnosis was often delayed, with patients experiencing prolonged illness before identification.
    • Radiological evidence of gas in the hemithorax was key in four cases, revealing fistulae (bronchial, esophageal, or both) in three.
    • All patients, except one moribund upon admission, survived initial treatment with open drainage; four without fistulae later achieved sinus closure.

    Conclusions:

    • Late-onset empyema post-pneumonectomy requires a high index of suspicion due to diagnostic difficulties.
    • Open drainage without tubes was effective for initial management and survival in this cohort.
    • The findings suggest that the pneumonectomy space may not always obliterate and that hematogenous spread could be an etiology for infection.