Residual Pleural Space after Lung Resection

Abstract

Approximately 10% of patients exhibit a residual pleural space after anatomical lung resection. The most common causes are related to interstitial lung diseases associated with reduced compliance and air leaks. If no complication occurs by the end of the 4th week, an uncomplicated course (absorption of air) can be expected. In the event of pleural space infection and/or bronchopleural fistula, there is a risk of aspiration, with the development of life-threatening pneumonia. In such cases, surgical treatment is indicated. The choice of surgical procedure is an individual decision, whereby the general condition, coexisting diseases, patient's mobility and motivation, pulmonary function, the lung tissue quality, the underlying disease with its prognosis and local as well as systemic effects of the pleural space infection must be taken into account. For the surgical therapy of the residual pleural space, the following methods are available: pleural drainage, pneumoperitoneum, pleura tent, lung decortication, space filling muscle transposition, thoracoplasty, thoracostomy, or combined procedures. Pleural drainage and decortication require an expandable lung. Postpneumonectomy empyema poses a particular challenge. To avoid a pleural space in cases of high risk conditions, prophylactic measures (pleural tent, pneumoperitoneum, N.phrenicus blockage) can already be performed during initial intervention.