Case Of Empyema Research Articles

Rare Case of Candida Parapsilosis Empyema Thoracis

BACKGROUND: This case report describes a patient with pleural empyema that grew Candida parapsilosis, an unexpected finding, especially in an immunocompetent individual with no prior surgery or trauma to the area. Candida empyema is a rare infection associated with mortality rates as high as 61.9%. METHODS: A 63-year-old male with a past medical history of pulmonary emboli was in his usual state of health when he developed worsening left-sided chest pain over 3 days, with associated shortness of breath and productive cough that was blood-tinged on occasion. Extensive imaging and a diagnostic thoracentesis confirmed an expanding left-sided parapneumonic effusion that was drained and found to grow Streptococcus anginosis and Candida parapsilosis. During his hospitalization, the patient also demonstrated increased alkaline phosphatase levels without abdominal pain or elevation in AST, ALT, or bilirubin, prompting further diagnostic imaging. Ultrasound of the abdomen showed a large, heterogeneous liver; follow-up CT scan, which was done without contrast due to worsening acute kidney injury, did not rule out liver masses. The patient’s clinical condition began to significantly improve following drainage of the pleural effusion and removal of the chest tube. After his kidney function returned to baseline, the patient was discharged with the remainder of his 18-day courses of amoxicillin-clavulanate and fluconazole, with a contrasted CT of the abdomen scheduled in the outpatient setting. CONCLUSION: This is an unusual case of fungal empyema, a severe manifestation of invasive candidiasis with a poor prognosis. Given the paucity of studies on Candida empyema, there is no definitive treatment for this deadly infection. A 2021 retrospective study of 81 patients with Candida empyema at two academic centers posited that optimal management included pleural drainage and fluconazole treatment. The same study found that 20% of Candida empyema originated from intra-abdominal sources. As for the patient in this case report, there remains the possibility that upcoming outpatient contrasted CT imaging of the abdomen will reveal the source of his infection.

Video Assisted Thoracoscopy Talc Pleurodesis in the Management of Metastatic Pleural Effusion

Introduction: Metastatic pleural effusion complicates many cancers and impairs patients' quality of life. In a palliative situation, the decision between thoracoscopy talc pleurodesis, tube chest, iterative punctures or abstention is difficult and often operator dependent. Materials and methods: We report a study of 87 patients with metastatic pleural effusion treated by video assisted thoracoscopy talc pleurodesis. Results: Breast cancer constitutes the primary site causing metastatic pleural effusion in approximately half of cases, followed by bronchopulmonary cancers and finally digestive cancers. The complete response rate in the short and medium term is very satisfactory. We did not report any complications apart from one case of empyema. Conclusion: video assisted thoracoscopy talc pleurodesis constitutes an interesting treatment for recurrence of metastatic pleural effusion.

Subdural empyema as a complication of odontogenic sinusitis: A case report

Odontogenic sinusitis represents between 10 and 40% of all cases of sinusitis in the population and may present with common symptoms such as nasal obstruction, anterior or posterior rhinorrhea, facial pain or pressure; and hypo- or anosmia. Although uncommon, intracranial and systemic suppurative complications have been previously reported in the literature and include brain abscess, epidural abscess and subdural empyema, associated with almost 100% morbidity and mortality, however, they are commonly related to meningitis, otogenic diseases and other sinus diseases. The aim of this study was to report a clinical case of intracranial subdural empyema associated with odontogenic infection in a previously healthy 17-year-old patient. This case highlighted the possibility of relevant complications, including even the patient's death, due to odontogenic sinusitis. Therefore, early dental planning and approach in a hospital environment are relevant and essential both in prevention and in the course of treatment, substantiating the multidisciplinary approach.

A case of Aspergillus empyema successfully treated by a single-stage cavernostomy and a covering procedure using both fat pad and muscle flap

BackgroundAspergillus empyema due to rupture of a pulmonary cavity including an aspergilloma is a serious condition especially in immunocompromised patients with various co-morbidities. Open window thoracotomy is usually performed to control infection, followed by secondary myoplasty. However, such a two-stage strategy requires long treatment period and accompanies the invasiveness of multiple operations. On the other hand, single-stage surgery is minimally invasive, and patients’ activities of daily living are less impaired. We present a single-stage surgery consisting of cavernostomy and a covering procedure using both fat pad and muscle flap.Case presentationA 28-year-old man taking 20 mg of prednisone for rheumatoid arthritis presented with right-sided chest pain. A chest computed tomography and thoracoscopy showed a perforated pulmonary cavity including an aspergilloma in the right apex of the lung. Antifungal medication was started, but the thoracic and pulmonary cavities persisted. Therefore, surgical intervention was indicated, and considering the patient’s general condition and anticipated length of treatment period, we decided to conduct a single-stage operation. A cavernostomy was performed on the ruptured cavity. To reliably close the air leak and to occlude the air space to prevent recurrence of infection, a subcutaneous free fat pad was harvested and filled into the cavity. A pedicled latissimus dorsi muscle flap was further introduced into the thoracic space to cover the fat pad. There was no postoperative air leak and the patient was discharged on postoperative day 20 with no adverse events and no limitation of movement in the arm. A series of post-operative CT showed that the pedicled latissimus dorsi muscle flap and free fat pad gradually shrank with lung re-expansion, but they were still present and filled the thoracic and pulmonary cavities 10 months after surgery.ConclusionA single-stage surgery consisting of cavernostomy and a covering procedure using both a fat pad and muscle flap was effective in sealing air leaks, filling the air space, and preventing recurrence of infection. The fat pad and muscle flap appear to have worked in a complementary way.

Perinephric and psoas abscesses leading to empyema: An unusual tuberculosis presentation

Tuberculous psoas abscess usually results from tuberculous spondylitis but may also develop from direct spread or via hematogenous route [1]. Our case involves direct spread from an adjacent perinephric abscess with associated thoracic extension from suspected direct erosion or a diaphragmatic defect. We present a case of pleural empyema arising from abdominal tuberculous abscesses. This is an 11-year-old male who initially presented with a three-week history of cough, intermittent fever, and dyspnea. Congenital diaphragmatic hernia was first suspected at the emergency department when an opacified left hemithorax with cystic lucencies was noted. Further imaging of the chest and upper abdomen was done in our institution revealing large left perinephric and psoas abscesses with intra-thoracic extension resulting in empyema thoracis and necessitans. Culture of the abscess fluid yielded no growth but GenExpert tested positive for M. tuberculosis. Tuberculosis remains a major illness in developing countries and has a multitude of infection sites and clinical presentation. Our case presented as an ascending thoracic extension of a perinephric and psoas abscess, likely from a diaphragmatic defect. The absence of spinal involvement proves its renal origin. The importance of CT scan is highlighted in medically-confounding cases such as this one.

Multidisciplinary treatment of thoracic fistulous empyema caused by pulmonary infection: a retrospective study.

In cases of thoracic empyema, the presence of a fistula is known to be difficult to treat and associated with a poor prognosis. Few reports have described the management of fistulous empyema caused by lung parenchymal infection. The aim of this study was to describe the outcomes of multidisciplinary management of fistulous empyema caused by pneumonia or lung abscess due to common bacteria and mycobacteria. Among 108 cases of empyema surgically treated at Kanagawa Hospital over a 10-year period, 14 patients with fistulous empyema due to common bacteria (CBFE) or fistulous empyema due to mycobacteria (MFE) were analyzed. Fistulous empyema due to lung resection was excluded. Eight out of the 9 patients with CBFE and 4 out of the 5 patients with MFE were male. Patients with CBFE were more likely to be >65 years of age (p=0.052) and to have a poor performance status (p=0.078). The time from onset to first surgical treatment was significantly longer in MFE (median, 5 months; p=0.004). Five patients with CBFE and two patients with MFE underwent open window thoracostomy, while three patients with CBFE and four patients with MFE underwent endobronchial occlusion (EBO). Six patients (66%) with CBFE and 3 patients (60%) with MFE achieved fistula closure. Of the patients who underwent EBO, fistula closure was achieved in 3 (100%) of the patients with CBFE and in 2 (50%) of the patients with MFE. Fistula closure was not achieved in any case with non-tuberculous mycobacteria. Fistulous empyema caused by common bacteria or Mycobacterium tuberculosis could be cured by surgical treatment and endobronchial intervention with adequate antimicrobial therapy, but fistulous empyema caused by non-tuberculous mycobacteria proved to be intractable. The challenge in the treatment of fistulous empyema due to non-tuberculous mycobacteria is the achievement of bacterial negativity.

Clinical profile, etiology, management and outcome of empyema thoracis associated with COVID-19 infection: A systematic review of published case reports

Objective: To explore the clinical features, diagnosis, etiology, treatment, and outcomes of COVID-19 related empyema. Methods: Using PRISMA statement, a systematic search of relevant case reports published between December 2019 and April 2023 was performed through seven databases. The collected data included demographics, clinical manifestations, diagnostic findings, treatment, and outcomes. Results: Thirty-six case reports were identified with 43 cases of empyema. The included cases had a median age of 55 years (range: 12-78 years) and 79.1% (34/43) were males. The majority of cases presented during hospitalization for management of acute COVID-19 infection (29/43, 67.4%) and Charlson comorbidity index <3 (40/43, 93.0%). Pseudomonas aeruginosa was the most commonly isolated microorganism from the pleural fluid (9/43, 20.9%) and 16.3% of the cases (7/43) had polymicrobial infections. Chest drainage was performed in all cases while surgery was indicated in 24 cases (55.8%). The most common complication of COVID-19-related empyema was broncho-pleural fistula (2/43, 4.7%). The mortality rate was 23.3% (10/43). Sepsis and/or multi-organ failure were the most commonly reported causes of death. On univariate analysis, no statistically significant risk factor for mortality was identified. Conclusions: COVID-19-associated empyema has a variety of predisposing factors, time of presentation, clinical features, and causative organisms. Invasive or minimally invasive surgical procedures are performed more frequently than isolated chest drainage. Empyema in COVID-19 patients worsens their prognosis and can lead to serious complications.

Microbiological study of empyema thoracis among children in a tertiary care hospital

Background: Empyema thoracis is a condition resulting in the accumulation of purulent fluid in the pleural cavity. It is a common source of illness among young children and is the most common sequela of bacterial pneumonia. Aims and Objectives: This study was to determine the clinico-microbiological profile, causative agents, and antimicrobial susceptibility patterns of the isolates of the study population. Materials and Methods: Prospective observational study was done in the Department of Microbiology, S. C. B. M. C. H., Cuttack. The study group comprised a total of 105 cases of empyema thoracis between the age group of 0–14 years, diagnosed by aspiration of pus from the pleural space. Complete histories of cases in detail were noted. Results: A total of 41% of patients were in the age group of 5–9 years with M: F ratio of 1.1:1. Maximum cases 36 (34.3%) were seen in the spring season. Fever, cough, and breathlessness were the most common complaints. Bronchopneumonia 56 (53.3%), impetigo, and skin lesions 29 (27.6%) were the major predisposing factors. Right-side empyema 71 (67.6%) was more common than the left side 34 (32.4%). Culture revealed Staphylococcus aureus as the most common etiologic agent 26 (36.1%), of which 30.8% were methicillin-resistant S. aureus, followed by Mycobacterium tuberculosis complex 13 (18.1%). Finally, 103 (98.2%) empyema cases were recovered by antibiotics and tube thoracostomy. Conclusion: Empyema thoracis is more prevalent in the lower socioeconomic population which can be prevented by an early diagnosis of pneumonia. Effective methods to treat empyema thoracis in children include the administration of proper antibiotics and tube thoracostomy in resource-poor settings.

An update on red blood cell transfusion in non-cardiac thoracic surgery.

The aim of this study was to evaluate risk factors for red blood cell (RBC) transfusion in non-cardiac thoracic surgery. All patients undergoing non-cardiac thoracic surgery in a single tertiary referral center between January and December 2021 were eligible for this study. Data on blood requests and perioperative RBC transfusion were retrospectively analyzed. A total of 379 patients were included, of whom 275 (72.6%) underwent elective surgery. The overall RBC transfusion rate was 7.4% (elective cases: 2.5%, non-elective cases: 20.2%). Patients with lung resections required transfusion in 2.4% of the cases versus 44.7% in patients undergoing surgery for empyema. In multivariable analysis, empyema (P=0.001), open surgery (P<0.001), low preoperative hemoglobin (P=0.001), and old age (P=0.013) were independent risk factors for RBC transfusion. The best predictor of blood transfusion was preoperative hemoglobin with a cut-off value <10.4 g/dL (sensitivity 82.1%, specificity 86.3%, area under the curve 0.882). The rate of RBC transfusion in current non-cardiac thoracic surgery is low, especially in elective lung resections. In urgent cases and open surgery, transfusion rates remain high, particularly in empyema cases. Preoperative requesting of RBC units should be tailored to patient-specific risk factors.

Diaphragmatic Injury with Empyema Development after Microwave Ablation of a Liver Dome Lesion.

Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the diaphragm and lung parenchyma. In this report, we present a case of diaphragmatic injury and subsequent empyema following MWA of a liver dome lesion.

Debate 2:Is the Management of Childhood Empyema Primarily Medical, or Surgical?

The management of empyema thoracis has changed in the past 1-2 decades with the advent of video-assisted thoracoscopy (VATS), the surgeon's weapon and fibrinolytic agents, the physician's weapon. Inappropriate use of either and inability to accept their failure in some cases cause prolonged morbidity in an unsuspecting patient. VATS has been shown to be very effective in stage 2 empyema and is associated with early amelioration of symptoms and early discharge from hospital. Open thoracotomy still plays an important role in the management of delayed and complicated cases of empyema and has always produced good results. Some complications seen by surgeons are related to previous interventions and delayed referral. Lung status plays an important role in post operative recovery. In patients requiring intervention, both medical and surgical options should be considered without bias early in the management and discussed with care-givers to give best outcome.

A prospective study of position selection combined with autologous blood intrathoracic infusion in the treatment of postoperative persistent air leakage with an unexpanded lung

We prospectively studied 17 patients with spontaneous pneumothorax or giant emphysematous bulla at Rizhao Hospital of Traditional Chinese Medicine from October 2020 to March 2022. All patients underwent thoracoscopic interventional therapy, had experienced continued air leakage for 3 days with closed thoracic drainage postoperatively, had an unexpanded lung on CT, and/or failed to intervention with position selection combined with intra-pleural thrombin injection(referred to as "position plus1.0"). They were all treated with position selection combined with autologous blood (100 ml) and thrombin (5 000 U) intra-pleural injection(referred to as "position plus 2.0").The success rate of the "position plus 2.0" intervention was 16/17, and the recurrence rate was 3/17. There were four cases of fever, four cases of pleural effusion, one case of empyema, and no other adverse reactions. This study has shown that the "position plus 2.0" intervention is safe, effective, and simple for patient with persistent air leakage failed to intervention with"position plus 1.0" after thoracoscopic treatment of pulmonary and pleural diseases related to bulla.

An independent prognostic factor in surgical cases of pleural empyema caused by common bacteria is the presence of a fistula.

Some surgical cases of pleural empyema lead to death despite multidisciplinary treatment. The purpose of this study was to identify prognostic factors in cases treated surgically for pneumonia-associated pleural effusions and empyema caused by common bacteria. We conducted a retrospective cohort study of 108 surgical patients of empyema who encountered at our hospital between 2011 and 2021. Patients were divided into surviving and non-surviving cases. Factors on admission (age, sex, body mass index, presence of fistula, performance status, pleural fluid culture results, HbA1c, albumin, leukocytes, hemoglobin, body temperature, heart rate, respiratory rate, systolic blood pressure, prognostic nutritional index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and RAPID score) were compared between the two groups. There were 87 cases of pleural empyema caused by pneumonia due to common bacteria. Variables that differed significantly in univariate analysis between the surviving and non-surviving cases in patients' characteristics on admission were fistula (p value < 0.001, odds ratio 20.000, 95% confidence interval 3.478-115.022), positive pleural fluid culture (0.016, 6.591, 1.190-36.502), body mass index < 18.5 (0.001, 16.857, 1.915-148.349), performance status 0-1 (0.007, 11.778, 1.349-102.858), and hemoglobin (0.024, 1.768, 1.077-2.904). Multivariate analysis showed significant differences in the presence of fistula (p = 0.036, CI 1.174-125.825). The odds ratio was 12.154. The mortality rate was 3.8% for non-fistulous empyema and 44.4% for fistulous empyema. In 6 of 9 cases of fistulous empyema, the fistula could be closed. Fistula was a significant independent prognostic factor for pneumonia-associated pleural effusions and empyema caused by common bacteria.

Consecutive Seven Serious Cases with Invasive Group A Streptococcal Infections at December 2022-January 2023.

To the Editors: During the second and third year of the COVID pandemic, an increased number of serious cases due to different microorganisms have been reported. In the second half of 2022, it has been reported that there has been an increase in invasive group A streptococcal (iGAS) infections in many countries including England, the Netherlands and others.1–3 iGAS is defined as a life-threatening invasive infection characterized by the isolation of Streptococcus pyogenes from normally sterile body fluids with culture or by pathogen-specific polymerase chain reaction (PCR). If GAS has grown from a probable carrier location, such as the throat, and the clinical course is compatible with GAS disease and no other causing organism has been found, these patients need to be handled as iGAS.4 Before the pandemic, GAS was the most common pathogen among children in Europe who had to be hospitalized for a community-acquired bacterial infection. Patients with GAS infection had a 12% impairment at discharge and a 2% fatality rate. Increases in toxic shock syndrome, necrotizing fasciitis and pleural empyema have all been linked to increased mortality.4 In UK, during the last couple of months, the rate per 100,000 population of iGAS is higher among children.1 Between December 2022 and January 2023, in our tertiary care facility, we followed up 7 consecutive cases of iGAS infection—3 boys and 4 girls, ages 37–96 months—without any relation to one another (Table 1). All children were previously healthy. Five children were admitted to the pediatric intensive care unit, including 1 with toxic shock syndrome and 4 with pleural effusion/empyema. In 6 out of 7 children, the diagnosis of iGAS infection was made based on a positive culture and/or PCR from a typically sterile place, with the pleural fluid being the most frequent site. iGAS infection was defined in a child with toxic shock syndrome based on positive throat culture. In Table 1, antibiotic therapy is displayed. Each patient received clindamycin and 1 patient received intravenous immunoglobulin (IVIG). Due to empyema, thoracic tubes had to be inserted in 5 patients. In 2 of the pleural empyema cases, tube thoracostomy was carried out; in the third video assisted thoracostomy and in the fourth, thoracotomy and decortication were carried out. One child with GAS bacteremia required surgery for mastoiditis, and throughout the course of the investigation, sinus venous thrombosis was detected. Five children required pediatric intensive care unit stay. The length of hospital stay ranged from 7 to 21 days. TABLE 1. - Clinical Characteristics of 7 Children with Invasive Group A Streptococcal Infection Patient Age (month) Gender Diagnosis Culture Multiplex PCR Treatment PICU Stay Length of hospital stay (day) 1 37 Girl Pleural Empyema - Pleural fluid Streptococcus pyogenes Meropenem + vancomycin + clindamycin IVIG Thoracotomy and decortication + 14 2 40 Girl Pleural Empyema Throat Streptococcus pyogenes Pleural fluid Streptococcus pyogenes Tube thoracostomy Ceftriaxone + clindamycin + 9 3 96 Girl Pleural Empyema - Pleural fluid Streptococcus pyogenes Meropenem + vancomycin + clindamycin Tube thoracostomy Video assisted thoracostomy + 15 4 62 Boy Bacteremia, Mastoiditis, Sinus vein thrombosis Blood Streptococcus pyogenes - Meropenem + vancomycin + clindamycin Mastoidectomy - 21 5 48 Boy Pleural Empyema - Pleural fluid Streptococcus pyogenes Ceftriaxone + vancomycin + clindamycin Tube thoracostomy + 10 6 59 Boy Toxic Shock Syndrome Throat Streptococcus pyogenes - Ceftriaxone + vancomycin + clindamycin + 7 7 42 Girl Bacteremia, Pleural Empyema Blood Streptococcus pyogenes - Ceftriaxone + clindamycin - 10 IVIG, intravenous immune globulin; PICU, pediatric intensive care unit. Both the frequency and morbidity of iGAS infections increased after the COVID-19 pandemic as before. While there was only one iGAS case during the previous 3 years, 7 patients in a row were hospitalized during a 2-month period in our setting. Clindamycin would be efficient to deactivate M-protein and these exotoxins because S. pyogenes has the cell wall M-protein that prevents complement activation and reduces phagocytosis. This would produce a positive outcome similar to our case series.4,5 Although culture is the gold standard method for diagnosis, molecular methods such as multiplex PCR are important in identifying the causative agent. Despite treatment, we have seen serious complications in our case series, such as pleural decortication, mastoiditis, sinus venous thrombosis and toxic shock syndrome. Early diagnosis of patients (using molecular techniques included) and the initiation of appropriate treatment including clindamycin, are crucial. To comprehend the postpandemic condition, it is essential to monitor the clinical findings and prognosis of iGAS cases from various countries.

Subdural empyema secondary to pansinusitis after coronavirus disease 2019 infection in an immunocompetent patient: illustrative case.

Superimposed intracranial infection is an uncommon but clinically significant complication in patients with active coronavirus disease 2019 (COVID-19), particularly in those with predisposing immunocompromising conditions. The authors describe a case of subdural empyema, secondary to extension from pansinusitis, in a 20-year-old otherwise healthy immunocompetent male who was recently diagnosed with COVID-19. Despite his critical condition at time of presentation, he made a full clinical recovery with aggressive multidisciplinary surgical management between neurosurgery and otolaryngology, despite negative cultures to guide directed antimicrobial therapy. Ultimately, use of molecular-based polymerase chain reaction testing diagnosed Aspergillus fumigatus as the offending pathogen after the patient had already recovered and was discharged from the hospital. This case demonstrates the potential for significant superimposed intracranial infection even in young, healthy individuals, infected by COVID-19 and suggests an aggressive surgical approach to achieve source control, particularly in the absence of positive cultures to guide antimicrobial therapies, may lead to rapid clinical improvement.

Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ2 test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ2=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ2=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ2=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.

471 - An infected chylothorax- an unusual case of spontaneous bacterial empyema

471 - An infected chylothorax- an unusual case of spontaneous bacterial empyema

Tubercular Subdural Empyema with Tubercular Abscess: Lessons Learnt

AbstractTuberculosis (TB) is still one of the major health care problems in many developing countries. Among various forms of TB, central nervous system (CNS) TB causes significant morbidity and mortality. CNS TB can present in various forms: cerebritis, abscess, meningitis, tuberculoma, calcified granuloma, meningitis, or hydrocephalus. But subdural empyema is a very rare form of presentation. Very few cases have been reported till now in the literature. So, high level of suspicion, thorough microbiological and histological investigations to diagnosis, and early and timely inception of anti-TB medication are keys in its management. Here, we are presenting a case of tubercular subdural empyema that was successfully treated with surgical evacuation and anti-TB medication.

Current morbimortality and one-year survival after pneumonectomy for infectious diseases

ObjectiveIdentify the one-year survival rate and major complications in patients submitted to pneumonectomy for infectious disease. MethodsRetrospective data from all cases of infectious disease pneumonectomy over the past 10 years were collected from two reference centers. The authors analyzed: patient demographics, etiology, laterality, bronchial stump treatment, presence of previous pulmonary resection, postoperative complications in the first 30 days, the treatment used in pleural complications, and one-year survival rate. Results56 procedures were performed. The average age was 44 years, with female predominance (55%). 29 cases were operated on the left side (51%) and the most frequent etiology was post-tuberculosis (51.8%). The overall incidence of complications was 28.6% and the most common was empyema (19.2%). Among empyema cases, 36.3% required pleurostomy, 27.3% required pleuroscopy and 36.3% underwent thoracoplasty for treatment. Bronchial stump fistula was observed in 10.7% of cases. From all cases, 16.1% were completion pneumonectomies and 62.5% of these had some complication, a significantly higher incidence than patients without previous surgery (p = 0.0187). 30-day in-hospital mortality was (7.1%) with 52 cases (92.9%) and 1-year survival. The causes of death were massive postoperative bleeding (1 case) and sepsis (3 cases). ConclusionsPneumonectomy for benign disease is a high-risk procedure performed for a variety of indications. While morbidity is often significant, once the perioperative risk has passed, the one-year survival rate can be very satisfying in selected patients with benign disease.

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.