Empyema thoracis in very old patients: reports of two clinical presentations.

Introduction. - Primitive thoracic empyema or empyema secondary to pneumoni a represents a significant medical problem necessitating prolonged hospital izations and increasing the rates of morbidity and mortality. Average patie nt age is 55 years and remains rare in very old patients (> 85). We report here two observations in very old patients, pointing out the diversity of t he clinical presentation. Exegesis. - Empyema thoracis is classically associated with underlying dise ases. It is often polymicrobial but Gram-positive bacteria and anaerobes ar e more frequent than Gram-negative bacteria. The clinical presentation may be aspecific without any parameters in favor of infectious disease: the rap idity of pleural drainage and antibiotic therapy are the main prognostic fa ctors. Conclusion. - Because of the diversity of clinical presentation in the elde rly population, and because of the efficiency of rapid treatment, geriatric physicians should perform an examination of pleural fluid when pleural eff usion is unknown. (C) 2001 Editions scientifiques et medicales Elsevier SAS .