Surgical management of empyema thoracis – experience of a decade in a tertiary care centre in India

Benjamin, Santhosh Regini; Panakkada, Rijoy Kolakkada; Andugala, Shalom Sylvester; Gnanamuthu, Birla Roy; Rao, Vinay Murahari; Narayanan, Deepak; Mohammad, Aamir; Mallampati, Sameer

doi:10.1007/s12055-020-01085-x

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…While this may be a life-saving procedure for some, it is not without complications. The most commonly documented complications are recurrent infections or narrowing of the thoracic window os requiring reopening 15. We found one case report of a patient developing a pleural space Marjolin ulcer due to chronic inflammation from an Eloesser flap 16.…”

Section: Discussionmentioning

confidence: 97%

Pulmonary Artery Bleed from an Eloesser flap

2022

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An open thoracic window involves the creation of a semi-permanent pleural-cutaneous connection to treat chronic organising empyemas, bronchopleural fistulas and postpneumonectomy empyemas in patients too ill for video-assisted thoracic surgery decortication. An Eloesser flap is a type of open thoracic window. Antibiotics have made the use of Eloesser flaps and other open thoracic windows for treatment of empyemas rare. Consequently, not much is known about the chronic complications of open thoracic windows. However, structural compromise of vasculature secondary to chronic inflammation has been previously proposed as a mechanism for spontaneous pulmonary haematomas related to anatomic deformation. We depict a case of spontaneous pulmonary arterial bleed presenting as chest wall haemorrhage due to a chronic modified Eloesser flap.

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Section: Discussionmentioning

confidence: 97%

Pulmonary Artery Bleed from an Eloesser flap

2022

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“…Early improper treatment of effusion can lead to many patients progressing to stage III empyema, when surgical intervention will be needed and surgical approaches should be more sophisticated if the empyema is not treated and resolved at this stage 10 . The effect of surgical approaches by decortication of the visceral and parietal pleura in the treatment of stage III tuberculous empyema is gradually becoming recognized and commonly used 6 , 11 . The optimum timing of surgery is crucial for achieving better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging

Liu,

Wang,

Sheng

et al. 2023

Sci Rep

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To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.

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