Image-guided percutaneous drainage of thoracic empyema: Can sonography predict the outcome?

Abstract

The aim of this study was to assess the safety and efficacy of image-guided percutaneous catheter drainage (IGPCD) of thoracic empyemas, and to correlate the outcome of IGPCD with the pre-procedural sonographic appearance. One hundred three patients (74 males and 29 females) with thoracic empyema (age range 1 month to 70 years, median age 28 years) underwent IGPCD. In 63 (61.17%) patients, IGPCD was the primary treatment modality; in 40 (38.84%) patients it was used after unsuccessful intercostal chest tube drainage (ICTD). Ultrasound was the main modality used for guidance; CT guidance was used in only 7 patients (6.8%). Eight- to 12-F pigtail catheters or 10- to 14-F Malecot catheters were used. The outcome was correlated with the pre-procedural US appearance (anechoic, complex non-septated or complex septated) of the empyema. The IGPCD technique was successful in 80 of 102 patients. Based on the US appearance, IGPCD was successful in 12 of 13 (92.3%) patients with anechoic empyemas; 53 of 65 (81.54%) patients with complex non-septated empyemas, and in 15 of 24 (62.5%) patients with complex septated empyemas. A statistically significant difference (p < 0.01) was seen in the outcome of IGPCD in the three categories. Twenty-two patients required further treatment: ICTD (n = 9; 2 of them later also underwent surgery); and surgery (n = 15). The duration of catheter drainage ranged from 2-60 days. No major complications were encountered. Percutaneous catheter drainage of thoracic empyemas with imaging guidance ensures accurate catheter placement with a high success and a low complication rate. Pre-procedural US can predict the likelihood of success of IGPCD.

Randomised trial of intrapleural urokinase in the treatment of childhood empyema

“…22 In our study ultrasonographic findings did not affect outcome and this differs from a report of image guided percutaneous drainage without the use of a fibrinolytic agent. 23 Furthermore, a recent report on the role of CT scanning and ultrasound in adult patients concluded that neither technique could reliably identify the stage of pleural infection or predict those who required surgical intervention. 24 Some differences were found between the groups at trial entry.…”

A practical guide to transthoracic ultrasound

“…These tubes are better tolerated than large bore (20-24 F) intercostal drains [25]. Some prospective studies have found that 8-12 F pigtail catheters or 10-14 F catheters inserted under ultrasonographic guidance are at least as effective as larger catheters [26][27][28].…”

Parapneumonic Pleural Effusion and Empyema

“…Buzdolabında bekletildiğinde S. pneumoniae, H. influenzae ve anaerobların üremesi inhibe olmaktadır. Plevra sıvısı pH, glukoz ve LDH düzeyleri tedavi yönteminin seçiminde ve tedaviye yanıtın değerlendiril-mesinde öncelikle gereklidir (16)(17)(18).…”