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Pleural empyema: 24-year experience

D Weissberg¹, Y Refaely

¹Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine.

The Annals of Thoracic Surgery

|October 1, 1996

Summary

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Empyema treatment can be guided by pleuroscopy, which helps identify causes of treatment resistance. Specific interventions like talc pleurodesis, decortication, or fenestration offer tailored solutions for better patient outcomes.

Area of Science:

Thoracic surgery
Pulmonology
Infectious diseases

Background:

Empyema remains a significant clinical challenge despite antibiotic use.
Treatment strategies for empyema are often debated.

Purpose of the Study:

To review the experience of managing 380 empyema patients.
To evaluate the utility of pleuroscopy in guiding treatment decisions.
To assess outcomes of various therapeutic interventions.

Main Methods:

Retrospective review of 380 patients diagnosed with empyema.
Classification of empyema stages: exudative, fibrinopurulent, and organizing.
Performance of pleuroscopy in 107 patients with treatment-resistant empyema.

Main Results:

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Pneumonia was the most common cause (n=308).
Pleuroscopy identified factors limiting lung expansion in 51 patients.
Mortality rate was low at 1.3% (5 patients).

Conclusions:

Pleuroscopy aids in identifying treatment resistance factors and facilitates pleural cleansing.
Talc pleurodesis can prevent pus reaccumulation in selected cases.
Decortication is optimal for organizing empyema, while fenestration is a life-saving option for critically ill patients.