PLEURAL EMPYEMA - 24-YEAR EXPERIENCE

Background. Despite the widespread use of antibiotics, empyema remains a common and serious problem, and its treatment is controversial. Met hods. Our experience in 380 patients with empyema was retrospectively reviewed. Results. The causes of empyema were as follows: pneumonia (n = 308), late complication of tuberculosis (n = 24), trauma (n = 15), pulmonary gangrene (n = 3), retained foreign body (n = 1), and undeter mined (n = 29). An exudative state was diagnosed in 273 patients, a fi brinopurulent state in 55, and an organizing state in 52. Pleuroscopy was performed in 107 patients resistant to treatment, and this reveale d an expansible lung in 49 patients, a nonexpansible lung in 51, and e xceptional findings (foreign body, necrotizing pneumonitis,and perfora ted esophageal cancer) in 7. Treatment was modified accordingly. Five patients died (mortality, 1.3%). Conclusions. Pleuroscopy is very help ful in disclosing factors responsible for resistance to treatment and in carrying out thorough pleural toilet. The use of talc in selected p atients causes pleurodesis and prevents the reaccumulation of pus. Dec ortication is the ideal treatment in the organizing stage, enabling co mplete lung expansion. Fenestration is lifesaving in moribund patients who cannot tolerate decortication.