Surgical Management of Pyothorax: A Series of 172 Cases

Abstract

Introduction: The pyothorax or thoracic empyema is defined by the presence between the two pleural layers of a purulent liquid, or a non-purulent liquid, but with bacteriological or biochemical characteristics testifying to a microbial invasion. The use of early medical treatment prevents the passage to pleural encystment, whose management remains surgical. Material and Methods: Our study was performed retrospectively, in the department of thoracic surgery of CHU Hassan II of Fez, between 2010 and 2016, involving 172 patients operated for pyothorax. Results: Among the 172 patients included in our study, there were 110 men and 67 women. The average age was 32.11 years old. The clinical picture was dominated by pleural syndrome in 56% of cases, signs of tuberculous impregnation in 44.1% of cases. Preoperative preparation with thoracic drainage, bi-antibiotic therapy and respiratory physiotherapy was performed in 90% of cases. The attack was right in 55.8% of cases and left in 44.1%. A chest CT scan performed in all patients showed pachypleuritis in all cases. The tuberculous pyothorax accounted for 54% of cases, those by intra pleural rupture of a pulmonary hydatid cyst in 10.4%, para-pneumonic origin in 5.2% and post-traumatic in 4.06%. The origin was undetermined in 26.16%. A conservative posterolateral thoracotomy was performed in all our patients. The pulmonary release was done through the extrapleural plane in 94% of cases, and pleuropulmonary decortication performed in all cases. Atypical resection was associated in 4.3% of cases and peri-cytectomy in 13.9% of cases. Operative follow-up was simple in 79.6% of cases. The main postoperative complications were a prolonged aerial leak in 16.7%, atelectasis in 4.5%, a wall infection in 6.5%, a hemothorax refrained in 3.2% of cases. The average follow-up was 2.5 years. Conclusion: Tuberculosis remains the most common etiology of pyothorax in our setting. Early management plays an important role in reducing the morbidity and mortality of this pathology. However, surgery remains the only effective treatment at the pleural encystment stage.