Abstract
Empyema, or “pus in the chest,” is the most common complication of pneumonia and is therefore a surgical emergency with which an acute care surgeon should be familiar. Diagnosis is made on the basis of clinical exam, radiographic imaging, and – most importantly – a pleural fluid analysis. Initial treatment consists of tube thoracostomy and possible intrapleural fibrinolytic therapy. Failure to improve clinically or radiographically requires immediate surgical intervention. Open thoracotomy and video-assisted thoracoscopic surgery (VATS) are the two valid approaches for decortication and drainage. In pediatric patients, VATS is preferred.
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