Management of empyema thoracis: Peshawar experience of 450 patients

Abstract

Objective: To observe the various clinical presentations of empyema thoracis and evaluate its management and outcome. Study design: An observational descriptive study. Place and duration: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital from June 2001 to June 2004. Materials and methods: Clinical record of 450 patients who underwent various surgical procedures during 3 years were retrospectively analyzed. Detailed scrutiny of record was carried out to analyze the clinical presentation; various surgical procedures and outcome. Results: There were 270 (60%) male and 180 (40%) female patients. Majority of the patients 310 (68.8%) were in the age range of 20 - 40 years. Common presentation was fever (62%); cough (26%) and chest pain (11%). The duration of symptoms was less than 8 weeks in 57 % and more than 8 weeks in 42% cases. Common etiologies were pneumonia (31%), post tuberculous (37.7%), traumatic (24%) and iatrogenic (6.6%). Tube thoracostomy was the initial l ine of management in 200 patients. Decortication was required in 200 patients while 50 patients needed thoracoplasty to obliterate persistent residual pleural space. The mortality was 4% (18/450). Thirty one (7%) had wound infection, air leak in 18 (4%), wound dehiscence in 9 (2%) and septicemia in 14 (3%) cases. Conclusion: Depending upon the stage, various surgical options exist for the treatment of thoracic empyema. Selection of the most appropriate procedure must be individualized but the basic principle is evacuation of pus from the pleural space, appropriate antibiotic therapy and obliteration of empyema cavity.