Occurrence and Management of Empyema Thoracis During Covid-19 Times

Abstract

Introduction: Empyema is defined as an infected pleural fluid collection, evidenced either by purulent fluid or the presence of bacterial organisms. The aim of this study is to highlight the importance of early diagnosis and management of empyema in an attempt to avoid needless procedures and dreaded complications while shining a light into the warrant of a multidisciplinary approach that would had a paramount significance during the lockdown period in Greece, between March-June of 2020 due to COVID-19, in ameliorating those issues. Patients and Methods: During the aforementioned period 12 patients were treated at our Department, 11 of them were male, ages ranging from 22-71 years old. The cause of empyema was parapneumonic effusion from a bacterial pneumonia in 10 patients and the other 2 were tuberculous empyema and extension of an intraabdominal process (Diffuse large B-cell lymphoma of the stomach). Predominately the patients were admitted to our Department with stage III empyema. Diagnosis was confirmed with CT scan and drainage of frank pus from the chest tube. All patients underwent chest tube insertion and antibiotic therapy nonetheless 9 of them required surgical management with VATS or open decortication. Results and Conclusion: The impedance in seeking medical advice due to fear of COVID-19 and the insufficiency of an interdisciplinary approach in the management of those patients were determined as the reason for such high admittance with stage III empyema. The decision of open vs VATS decortication was made based on the medical status and history of each individual, the stage of the empyema and ultimately our ability to achieve the two primary goals of empyema treatment, complete evacuation, and lung reexpansion [1]. Eight patients underwent open decortication and drainage and one managed with VATS decortication. Postoperative complications were encountered in 3 patients which included prolonged air leak, surgical wound infection, and septic shock. One patient died from multiple organ failure due to postoperative septic shock. The duration of chest tube drainage varied from 5-15 days. The mean hospital stay was 13,5 days.

Culture-negative pleural empyema after Coronavirus disease-19 resolution – A case report

“…Empyema is purulent pleural fluid caused by infection. It usually arises from parapneumonic effusion from bacterial infection -- causing pleural inflammation – that evolves into a full-blown pleural infection [ 3 ]. In COVID-19 setting, the incidence of COVID-related pleural effusion is highly varied across numerous observational studies.…”

“…Those aged 60 years old or above and with severe diseases are the main risk factors [ 4 ]. Unilateral exudative effusion with high LDH and fluid-serum LDH ratio is predominant in such patients [ [3] , [4] , [5] , [6] ].…”