[Treatment of pleural empyema].

Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
M KloppH Dienemann

Abstract

Pleural empyema remains a frequently encountered clinical problem and is responsible for significant morbidity and mortality worldwide. Its diagnosis may be difficult; delays in diagnosis and treatment may contribute to morbidity, complications, and mortality. The management of parapneumonic effusion and empyema depends on timely, stage-dependent therapy and the underlying etiology. Thoracentesis and antibiotics remain the cornerstones of treatment in stage I disease. In the early fibrinopurulent phase (stage II) thoracoscopic methods should be considered. As treatment strategy for this stage, fibrinopurulent pleural empyema entails thorough debridement of multiloculated collections from the pleural cavity by video-assisted thoracic surgery. After evacuation of multilocular effusions and the removal of fibrin deposits with drainage by two intercostal chest tubes, irrigation treatment helps to achieve clarity of the pleural discharge. Open thoracotomy and decortication are reserved for organized, multiloculated empyema with lung entrapment (stage III disease). Early drain removal may lead to rapid symptomatic recovery and complete resolution.

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Citations

Mar 30, 2010·General Thoracic and Cardiovascular Surgery·Hiroshige NakamuraTomohiro Haruki
Feb 16, 2010·AORN Journal·Rajaraman DuraiTony W Davies
Jan 16, 2009·Orvosi hetilap·Jeno Malomsoki
Oct 25, 2013·Disability and Rehabilitation·Shaun Cleaver, Stephanie Nixon

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