Abstract
BackgroundThe treatment of early pleural empyema depends on the treatment of ongoing infection by antimicrobial therapy along with thoracocentesis. In complicated empyema this treatment does not work and lung will not expand until removal of adhesions. The objective of the current study is to analyze the experience of management of multiloculated, exudative and fibrinopurulent empyema through rigid medical thoracoscopy under local anaesthesia and to explore new ways to manage the entity.MethodsThis is a descriptive case series in which 160 patients were recruited through non-probability convenient sampling, from department of pulmonology, Jinnah postgraduate medical centre, Karachi, from September 2014 to August 2016. All patients underwent medical thoracoscopy under local anesthesia. Written Informed consent was taken from the study participants. Ethical approval was obtained from Ethical Review Committee of the hospital. Patients age > 70 years, those with multiple organ failure and bleeding disorders were excluded.ResultsOut of 160 patients, 108 (67.50%) were male and 52 (32.5%) were female with mean age 25.37 years (range 16 to 70 years). Out of total, 102 (63.7%) had tuberculous empyema, while pleural biopsy of 58 (36.3%) patients was suggestive of non-tuberculous empyema. Final evolution through chest x-ray revealed complete resolution in 92 (57.5%), partial resolution in 58 (36.25%) patients. 9 (5.6%) developed persistent air leak while 1 (0.6%) patient expired due to urosepsis.ConclusionMedical Thoracoscopy under local anesthesia is a safe, efficient and cost effective intervention for management of complicated empyema, particularly in resource constraint settings.
Highlights
The treatment of early pleural empyema depends on the treatment of ongoing infection by antimicrobial therapy along with thoracocentesis
Pleural empyema is defined as pus accumulation in the pleural space; it is associated with significant morbidity and mortality in adults and children [1]
Medical thoracoscopy is at the stage of its inception in Pakistan and there are only few centers scattered in the country doing this procedure, while the use of this minimally invasive procedure was introduced in 1910 in Europe to diagnose and treat pleural diseases [4, 9, 10]
Summary
The treatment of early pleural empyema depends on the treatment of ongoing infection by antimicrobial therapy along with thoracocentesis In complicated empyema this treatment does not work and lung will not expand until removal of adhesions. Pleural empyema is defined as pus accumulation in the pleural space; it is associated with significant morbidity and mortality in adults and children [1] It can be subdivided into three stages: Stage 1: exudative which is freely moving pleural fluid, Stage 2: fibrino-purulent in which fibrin deposits on the pleural surfaces with a turbid, viscous fluid which has a tendency to loculate, and Stage 3: organizing which is characterized by fibrous thickening of the visceral pleura leading to a trapped lung by fibrous adhesions on pleura. Diaphragmatic movement can be visualized in real-time which is reduced in heavily septated effusions or fibrothorax [4]. Medical thoracoscopy is a least invasive procedure that provides access to the pleural space using a combination of visualizing and working instruments
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