Abstract
PURPOSE: Managing the infected apical pleural space remains a rare but significant challenge for the thoracic surgeon. Decortication of the infected space is usually unsuccessful. Empyema tube or open (Eloesser) thoracostomy is poorly tolerated by patients in the apical position. Muscle transposition may be helpful, but options can be limited in the reoperative setting. Poor underlying lung function often makes completion pneumonectomy with Eloesser and subsequent closure (Clagett procedure) untenable.
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