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Respiration. 2012;84(3):219-24. doi: 10.1159/000339414. Epub 2012 Jul 24.

Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema?.

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  • 1Department of Disease of the Thorax, Pulmonology Unit, Morgagni Hospital, Forl√¨, Italy.

Abstract

BACKGROUND:

Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment.

OBJECTIVES:

The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema.

METHODS:

We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011.

RESULTS:

A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%).

CONCLUSIONS:

Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate 'pockets' not in apparent communication with each other often leads to a surgical approach.

Copyright © 2012 S. Karger AG, Basel.

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PMID:
22832393
[PubMed - indexed for MEDLINE]
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