OPEN DRAINAGE OF MASSIVE TUBERCULOUS EMPYEMA WITH PROGRESSIVE REEXPANSION OF THE LUNG - AN OLD CONCEPT REVISITED

Background. This study examined the results of open drainage of massiv e tuberculous empyema. Methods. During a 7 year period 47 patients wit h primary mixed chronic tuberculous empyema with near or total lung; c ollapse were treated. The initial procedure was chest tube suction dra inage, which permitted evaluation of;the pleural cavity and the lung p arenchyma despite minimal if any reexpansion of the lung. All patients were treated with antibiotics and multidrug regimens of antituberculo sis agents. A pleurocutaneous window was established by removing secti ons of two ribs one intercostal space above the base of the pleural ca vity. Irrigation was performed daily with dilute povidone iodine solut ion. Results. Twenty-eight patients achieved complete reexpansion of t he lung after 4 to 30 months of drainage and are cured. Eleven are in various stages of reexpansion and probably will be cured. Eight patien ts did not achieve reexpansion. Criteria were established retrospectiv ely on an ongoing basis that indicate when pulmonary reexpansion is po ssible. Conclusions. These totally collapsed ''entrapped'' lungs expan ded to fill the entire pleural space despite the presence of bronchopl eural fistulas and an ''open'' pleura. Reexpansion tvas progressive, g radual, and dependent on improved compliance, clearing of bronchial in flammation and obstruction, and pleural cleansing. Criteria are establ ished that identify those patients in whom complete reexpansion may ta ke place and the disease may be cured.