OPEN WINDOW THORACOSTOMY, MYOPLASTY, AND EPIPLOPLASTY FOR TREATMENT OF POSTPNEUMONECTOMY EMPYEMA - CT EVALUATION

PURPOSE: To demonstrate the computed tomographic (CT) appearance of th e postpneumonectomy space (PPS) after surgical treatment of postpneumo nectomy empyema.MATERIALS AND METHODS: The authors retrospectively rev iewed 22 CT scans obtained in 15 patients after open window thoracosto my (OWT) (n = 4), myoplasty (n = 12), and epiploplasty (n = 1). RESULT S: After uncomplicated OWT, the retracted PPS contained air and/or gau ze without residual pleural fluid. After uncomplicated myoplasty, mark ed retraction of the operated hemithorax was observed. CT allowed loca lization of transposed muscle flaps and fatty tissue within the PPS A moderate amount of fluid and air was present during the Ist month afte r surgery. After uncomplicated epiploplasty, the retracted PPS contain ed homogeneous tissue with characteristic fatty attenuation. Complicat ions including recurrent empyema, recurrent bronchopleural fistula, as eptic fluid collection, necrosis and fatty transformation of muscle fl aps, and tumor recurrence were accurately demonstrated. CONCLUSION: CT is useful in follow-up after surgical treatment of postpneumonectomy empyema because it permits accurate evaluation of the PPS.