A case of empyema after plastic ball plombage cured by air-plombage method

Abstract

Conventionally, thoracoplasty has been conducted for empyema space after removal of plastic ball for empyema cases after plastic ball plombage. We applied air-plombage method for empyema as a new operative technique. The patient was a 56-year-old man who had had 37 plastic balls implanted for the treatment of pulmonary tuberculosis 39 years ago. In April 1988 he was admitted to our department complaining bloody sputum and high fever. Roentogenographic findings revealed residual middle lobe with normal size and plastic balls some with niveau. From these findings, the case was diagnosed as partial empyema after plastic ball plombage. In June 1988 air-plombage method was performed. At 5 months after operation, reinflation of the residual pulmonary lobe was seen accompanying improvement of pulmonary functions; FVC increased from 1780 ml to 1910 ml and blood gas PaO2 from 75.0 mmHg to 88.3 mmHg. Blood loss during operation was about 2,000 ml, which was smaller than the conventionally experienced amount of blood loss. Because of residual right middle lobe, pulmonary decortication was impossible and significant reinflation of the collapsed pulmonary lobe could not be expected. We selected air-plombage method rather than thoracoplasty as postoperative worsening of pulmonary functions was anticipated by the latter. Postoperative improvement of pulmonary functions could be explained by reinflation of the residual lobe due to removal of plastic balls and the capsule. When conventional thoracoplasty is carried out to obtain satisfying closure of the empyema cavity, pulmonary functions are always deteriorated, while air-plombage method is followed by slight improvement of pulmonary functions.(ABSTRACT TRUNCATED AT 250 WORDS)