INTRACAVITARY APPLICATION OF CONTRAST-MED IUM IN THE FOLLOW-UP OF COMPLICATED TUBE-DRAINED PLEURAL EMPYEMA - CONVENTIONAL RADIOGRAPHY VS CT

Intracavitary application of contrast medium in the followup of compli cated tube-drained pleural empyema: Conventional radiography vs CT. Pu rpose: To define the value of conventional radiography compared with C T in the follow-up of complicated, long-term tube drained pleural empy ema after intracavitary application of contrast medium. Methods: 28 pa tients with complicated pleural empyema (stage III) and longterm tube drainage were submitted to fluoroscopy of the pleural cavity and a CT of the thorax after contrast medium had been instilled into the pleura l space. Both examinations were judged by the following criteria: numb er and morphology of pleural cavities, quality of drainage and accompa nying thoracic disease. Results: 49 pleural cavities were diagnosed. J udgement of drainage corresponded in 79% of cases and differed in 21% with proof of further not drained cavities only on CT. 4 bronchopleura l fistulas were diagnosed by fluoroscopy, of which only 2 were evident on CT. Accompanying thoracic disease was reliably detected by CT only . Conclusions: Diagnosis of bronchopleural fistulas and judgement of t he pleural drainage is best possible using fluoroscopy after applicati on of contrast medium into the pleural space. CT is most accurate to d etect further cavities that have not been drained, to look for concomi tant thoracic disease, and to judge the morphology of the pleural cavi ty. Conventional radiography of the pleural space is effective and rec ommended to be used as a first line investigation for the follow-up of stage III empyemas. Patients in poor general condition (fever, elevat ed blood markers indicating inflammation) should be examined by both f luoroscopy and CT.