Thoracoscopic management of early stages of empyema: is this the golden standard?

Elsayed, Hany; Mostafa, Ahmed; Fathy, Essam; Diab, Haytham S.; Nofal, Ibrahim Mostafa; AbdelHamid, Osama Abbas; Elbawab, Hatem; Elnori, Ahmed

doi:10.21037/jovs.2018.05.18

Cited by 14 publications

(15 citation statements)

References 21 publications

(45 reference statements)

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“…After inserting the drain into the pleural cavity, it should be connected to a bottle drainage system or to a chest tube drainage system and then connected to a suction source (if suction drainage is required) or left as an underwater seal drainage [6,32]. In many hospitals drainage of the pleural cavity is still the basic method of pleural empyema treatment, especially in its early stage [1,3,6,33]. However, in the case of an advanced stage of disease, classical pleural cavity drainage may be ineffective [1,3,6,33,34].…”

Section: Drainage Of the Pleural Cavitymentioning

confidence: 99%

“…In many hospitals drainage of the pleural cavity is still the basic method of pleural empyema treatment, especially in its early stage [1,3,6,33]. However, in the case of an advanced stage of disease, classical pleural cavity drainage may be ineffective [1,3,6,33,34].…”

Section: Drainage Of the Pleural Cavitymentioning

confidence: 99%

“…In recent years, the use of early thoracoscopic intervention in the treatment of pleural empyema has been growing in popularity [33][34][35][36][37]. The introduction of the thoracoscope to the pleural cavity enables precise assessment of the empyema, separation of septations and connection of the empyema loculations, evacuation of purulent content, pleural stratifications and fibrin conglomerates, as well as lung decortication [3,35,37,38].…”

Section: Thoracoscopymentioning

confidence: 99%

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Methods of treatment of pleural empyema in children

Barglik¹,

Korlacki²,

Grabowski³

2019

polp

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Pleural empyema is caused by the accumulation of purulent content in the pleural cavity. In recent years, a higher incidence of pleural empyema in children has been observed. Pleural empyema is usually caused by the passage of infection from inflamed pulmonary tissue. The appropriate medical imaging and laboratory tests, including microbiological examination of the pleural cavity contents, enable the initiation of proper methods of treatment. Depending on the clinical condition of the patient, variable methods of treatment are used, such as: antibiotic therapy with simultaneous systemic therapy, thoracentesis, pleural cavity drainage with optional intrapleural fibrinolysis, thoracoscopic debridement of the accumulated effusion and fibrin accumulation, as well as lung decortication via open surgery or by thoracoscopic technique.

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Section: Drainage Of the Pleural Cavitymentioning

confidence: 99%

Section: Drainage Of the Pleural Cavitymentioning

confidence: 99%

Section: Thoracoscopymentioning

confidence: 99%

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Methods of treatment of pleural empyema in children

Barglik¹,

Korlacki²,

Grabowski³

2019

polp

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“…However, samples obtained from BAL often prove invaluable in yielding information about the dysplastic nature of cells and any underlying infectious ailment. Similarly, pleural fluid analysis is used to guide the management and is recommended for patients suffering from pneumonic illness and ongoing sepsis who have a subsequent pleural effusion with a depth >10 mm [6,11]. The relative ease of access to the percutaneous pleural space for tapping pleural effusion leaves the procedure liable to various complications [12].…”

Section: Introductionmentioning

confidence: 99%

The Utility of Intraoperative Microbiological, Cytological, and Histopathological Sampling in the Setting of an Empyema Necessitating Lung Decortication Surgery

Niaz

Almas

Phelan

et al. 2020

Cureus

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Introduction and Aims: Empyema thoracis is a pleural space pathology that indicates accumulation of purulent material in the pleural space. It is often associated with an underlying infectious process, such as pneumonia, but can also be a ramification of a more sinister etiology, such as lung carcinoma, often warranting lung decortication surgery for prompt resolution. Although radiological imaging is used to form a preliminary diagnosis, its true predictive value remains questionable, and intraoperative microbiological, cytological, and histopathological samples are thus instrumental in yielding helpful diagnostic information. This study aims to gauge whether intraoperative microbiological, cytological, and histopathological analyses yield any additional diagnostic information in establishing the etiology underlying empyema, necessitating decortication surgery. Methods: Microbiological, cytological, and histopathological records of 43 patients undergoing decortication surgery were included in this study. Only patients who were diagnosed with late stages of empyema and subsequently underwent decortication surgery were included in this study. Results: The sample consisted of 43 patients, including 23 males and 20 females. For microbiology, 4.88% of the bronchoalveolar lavage (BAL) samples, 7.69% of tissue fluid samples, and 7.32% of pleural fluid samples were positive for an infectious microorganism. For cytology/histopathology, 0.00% of BAL samples, 5.41% of pleural fluid samples, and 7.32% of tissue samples were positive for an underlying infective etiology. Conclusion: For the study and analysis of the microbiological samples, a myriad of all three different modalities of diagnosis is essential. However, tissue sampling is the preferred modality of diagnosis for cytology/histopathology owing to its ability to detect positive cases that might otherwise evade prompt detection.

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“…Eradicating pus cavity is essential for treatment [ 2 ]. The efficacy of video-assisted thoracic surgery (VATS) in empyema management have been evaluated in several studies showing favourable results [ [3] , [4] , [5] ], less is known about the role of intrapleural anhydrous ethanol, which appears to be safe and successful in tuberculous empyema treatment. It is also lower in cost and better tolerated in frail patients than VATS which has a relatively greater trauma.…”

Section: Introductionmentioning

confidence: 99%

Treatment of chronic tuberculous empyema by intrapleural injection of anhydrous ethanol

Nie

Tao²,

et al. 2019

Respiratory Medicine Case Reports

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BackgroundAnhydrous ethanol, for its part, has been successfully used to treat renal cyst, hepatocellular carcinoma and ovarian chocolate cyst et al. However, in spite of the high frequency of tuberculous purulent pleural effusion, we found that only a few very early studies that attempted to assess the use of intrapleural anhydrous ethanol in tuberculous effusions with signs of empyema. We report a patient who was injected anhydrous ethanol into pleural cavity to treat chronic tuberculous empyema.Case presentationA 23-year old male was admitted in the hospital because of chronic tuberculous empyema. Ultra-sonography guided thoracentesis and thoracic close drainages were done, but had no effect. However, the patient refused Video-assisted Thoracoscopic Surgery (VATS) and traditional thoracotomy. Therefore, we injected anhydrous ethanol into the pleural cavity after getting the patient's consent. Pyothorax was quickly controlled and the patient finally recovered fully.ConclusionSurgical operation is the main treatment of chronic tuberculous empyema, which has a high cost and large injury, and many patients do not accept this treatment. In this study, intrapleural injection of anhydrous ethanol could achieve the purpose of eliminating the pus cavity, which is particularly suitable for patients who cannot tolerate surgery or are unwilling to undergo surgical treatment.

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Thoracoscopic management of early stages of empyema: is this the golden standard?

Cited by 14 publications

References 21 publications

Methods of treatment of pleural empyema in children

Methods of treatment of pleural empyema in children

The Utility of Intraoperative Microbiological, Cytological, and Histopathological Sampling in the Setting of an Empyema Necessitating Lung Decortication Surgery

Treatment of chronic tuberculous empyema by intrapleural injection of anhydrous ethanol

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