Pleural Decortication Research Articles

Pleural space management after lung transplant: Early and late outcomes of pleural decortication

Pleural complications after lung transplant may restrict allograft expansion, requiring decortication. However, its extent, indications, risk factors, and effect on allograft function and survival are unclear. From January 2006 to January 2017, 1,039 patients underwent primary lung transplant and 468 had pleural complications, 77 (16%) of whom underwent 84 surgical decortications for pleural space management. Multivariable time-related analysis was performed to identify risk factors for decortication. Mixed-effect longitudinal modeling was used to assess allograft function before and after decortication. Cumulative number of decortications per 100 transplants was 1.8, 7.8, and 8.8 at 1 month, 1 year, and 3 years after transplant, respectively. Indications for the 84 decortications were complex effusion in 47 (56%), fibrothorax in 17 (20%), empyema in 11 (13%), and hemothorax in 9 (11%). Thoracoscopic operations were performed in 52 (62%) and full lung re-expansion was achieved in 76 (90%). Complications occurred after 30 (36%) decortications, with 15 pulmonary complications (18%), including 2 patients requiring extracorporeal support due to worsening function. Ten reinterventions occurred via thoracentesis (2), tube thoracostomy (1), and reoperation (7). In-hospital and 30-day mortality was 5.2% (n = 4/77). Forced expiratory volume in 1 second increased from 50% to 60% within the first year after decortication, followed by a slow decline to 55% at 5 years. Postdecortication survival was 87%, 68%, and 48% at 1, 3, and 5 years, respectively. Despite high risk of reoperative surgery, decortication after lung transplant allows salvage of pleural space and graft function with a reasonable morbidity profile.

Tunneled Pleural Catheter to Manage Recurrent Post-Transplant Effusion

<h3>Introduction</h3> Pleural effusions after lung transplant (LT) are common and use of chest tubes is routine. Chronic pleural effusion post-LT, can impede attainment of best pulmonary function. Therapeutic interventions may include tube thoracostomy, pleural decortication, and pleurodesis. Due to concerns related to immunosuppression and fears of infection, tunneled pleural catheters (TPC) are not typically considered post-LT. <h3>Case Report</h3> A 71-year-old female with IPF underwent an uncomplicated right LT and chest tubes were weaned in the usual fashion. As an outpatient, pulmonary function and physical recovery were below expectations and imaging demonstrated pleural effusion. Given multiple recurrences despite tube thoracostomy and impaired physical recovery, a TPC was considered. Following sterile TPC placement, the patient was able to drain her effusion at home, while increasing participation in rehabilitation, ultimately achieving functional independence. The catheter was removed when pleural output was minimal and spontaneous pleurodesis was assumed. The patient suffered no infectious complications and at one-year, pleural effusion has not recurred. <h3>Summary</h3> Prolonged or recurrent pleural effusions following LT may cause dyspnea and impede functional recovery. While TPCs are typically used to control malignant or benign effusions, they can provide several advantages in the LT population. Tunneling reduces infectious risk, low profile avoids accidental dislodgement, and they can be placed and managed as an outpatient, avoiding setbacks associated with a surgical procedure. With malignant pleural effusions, these catheters relieve symptoms and by 6 weeks, 45% may achieve spontaneous pleurodesis. Though shown to be safe in a case series of LT recipients, these catheters are rarely used post-LT. Infection is a feared complication, though occurs in only 5% of patients, with empyema seen in about 3% of cases. In appropriately selected patients, TPCs may be a viable alternative to manage recurrent pleural effusions.

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The interesting case of Lemierre syndrome requiring pleural decortication described by A. T. Lanfear and colleagues is of particular clinical interest, as it emphasizes the high intensity of surgic...

Pulmonary Epithelioid Haemangioendothelioma Involving Pleura: A Case Report

Abstract Introduction/Objective Pulmonary epithelioid haemangioendothelioma is a rare, low to intermediate grade tumor of endothelial origin. It is more common in middle aged women. In lung, more than 60 % of the cases present as bilateral multiple perivascular nodules on imaging raising the differential of metastasis or inflammatory cause. WWTR1- CAMTA1 fusion gene is characteristic for this entity. Evidence of pleural involvement carries a poor prognosis. Methods Here, we present a case of epithelioid haemangioendothelioma involving pleura in a 52-year-old woman with a long standing history of rheumatoid arthritis. Patient presented with recurrent pleural effusions and shortness of breath. Results A diagnosis of epithelioid haemangioendothelioma was made on her pleural decortication specimen that showed atypical vascular proliferation and confirmed by immunohistochemical staining. Subsequent right lung wedge resection performed later confirmed the presence of epithelioid haemangioendothelioma in lung parenchyma. Conclusion Pathologists should be aware of this rare condition that can clinically present in a very deceptive manner of recurrent effusion.

RETROPHARYNGEAL ABSCESS WITH MEDIASTINITIS REQUIRING VIDEO-ASSISTED THORACOSCOPIC SURGERY

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Retropharyngeal abscesses are rare in adults. We present a case of anterior and posterior mediastinitis and empyema secondary to retropharyngeal abscess requiring video-assisted thoracoscopic surgery (VATS) and median sternotomy. CASE PRESENTATION: A 58-year-old male with chronic obstructive pulmonary disease presented to the ED with 2 days of right sided pleuritic chest pain with associated worsening dyspnea on exertion, odynophagia/dysphagia, hoarseness, and night sweats over the past two weeks. He had two prior ED visits with milder symptoms where he was cleared by ENT and sent home with oral corticosteroids. No history of immunosuppression, recent drug use, or odontogenic procedures. He was afebrile, tachycardic, and saturating 95% on 2 L nasal cannula. Exam was significant for neck swelling with tenderness of the submandibular region and right chest wall along with expiratory coarse prolonged wheezes. Labs were notable for leukocytosis with neutrophilia and bandemia. He was started on corticosteroids and broad spectrum antibiotics. Computed tomography (CT) of the neck showed a rim enhancing hypodensity around the post cricoid region of the hypopharynx with extension into the anterior mediastinum (Figure 1). He had emergent incision & drainage by ENT and thoracic surgery where a Jackson-Pratt drain was placed. Repeat imaging revealed progression with a loculated empyema and mediastinal tracking which required VATS with right pleural decortication (Figure 2 & 3). Two days later, the patient's clinical status did not improve despite broad spectrum antibiotics and drainage and he required a median sternotomy with washout of the anterior/posterior mediastinal fluid collections and three chest tubes. Abscess cultures were positive for Streptococcus parasanguinis, Rothia mucilaginosa, and Candida glabrata. All drains were removed after minimal drainage. On discharge, he was requiring oxygen with exertion and went to a long term acute care hospital to continue broad spectrum antibiotics. DISCUSSION: Retropharyngeal abscess can be associated with high mortality and morbidity (1). It may be secondary to accidental penetrating trauma, iatrogenic, or spread of oropharyngeal infection (2). This case is unique in that there was no clear etiology for the retropharyngeal abscess. Deep neck infections tend to follow the path of least resistance of the well-defined cervical fascial planes and can lead to pericardial and pleural effusions. High index of suspicion should be entertained for patients presenting with fevers, sore throat, and dysphagia. Contrast enhanced CT imaging is utilized to characterize the extent of the abscess. Management typically requires surgical intervention and intravenous antibiotics. CONCLUSIONS: Descending mediastinitis can be life-threatening if not diagnosed promptly. Early intervention with surgical management and antibiotics is vital to improved outcome. Reference #1: Jain H, Knorr TL, Sinha V. Retropharyngeal Abscess. In: StatPearls. StatPearls Publishing; 2020. Accessed May 30, 2020. http://www.ncbi.nlm.nih.gov/books/NBK441873/ Reference #2: Mark R, Song S, Mark P. Taking heed of the ‘danger space’: acute descending necrotising mediastinitis secondary to primary odontogenic infection. Case Rep. 2018;2018:bcr-2018-225019. doi:10.1136/bcr-2018-225019 DISCLOSURES: no disclosure on file for Frank Ajatta; No relevant relationships by Venkata Bandi, source=Web Response No relevant relationships by Lorraine Cornwell, source=Web Response No relevant relationships by Kalpalatha Guntupalli, source=Web Response My spouse/partner as a Consultant relationship with Abbvie Please note: $1-$1000 Added 05/27/2020 by Ebtesam Islam, source=Web Response, value=Consulting fee No relevant relationships by Sarah Jaroudi, source=Web Response

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal.

The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.

Postoperative Bleeding from the Pulmonary Artery Stump Due to Inflammatory Erosion Caused by Aspergillus Infection: First Case of the Literature

The term aspergillosis describes the disease caused by Aspergillus species. The most common pathogen in this genus is Aspergillus fumigatus. Anatomic pulmonary resection is the preferred treatment modality in most of cases especially the presence of the localized disease, but sometimes patients complicate by prolonged air leakage, pleural space problems, and infection of this residual space. We reported a patient who undergone left upper lobectomy because of aspergilloma in the left upper lobe. After the operation, the patient’s condition became complicated because of expansion failure of the lung and space problems. After the period of conservative treatment, urgent re-operation was needed because of acute hemorrhage from the chest tube. Hemorrhage was controlled, but disseminated pleural aspergillosis and infection in the pulmonary arterial stump were seen in the thoracic cavity. Completion pneumonectomy and pleural decortication were applied, and the antifungal therapy was arranged. With this report, we aim to evaluate the relation between disseminated pleural aspergillosis and inflammatory erosion of pulmonary arterial stump. It is also important to consider possibility of dissemination of the Aspergillus infection especially in patients with expansion failure after lung resection.

Outcomes of pleural decortication in a tertiary care hospital of Telangana state

Background: The objective of the study was to study the clinical profile, incidence of postoperative complications in patients undergoing pleural decortication.Methods: The subjects for the study were selected from the cases admitted in a single unit of Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad during the period of 2016 to 2018 and due ethics committee approval was taken. Collection of data is done from the database including admission record, ICU charts, discharge records and follow-up records. 50 patients underwent surgery. Outcomes and complications were analyzed for 3 years duration.Results: 50 patients were included in this study with different aetiologies that required pleural decortication. The average age of patients in our study was 34 years. Most patients in our study were male (80%) and had history of infection with tuberculosis (42%) and pyogenic (28%) infection. A few patients had history of trauma (12%). Most of the patients suffered from cough (88%), dyspnoea (74%), fever (82%) and haemoptysis (22%). The common postoperative complications we encountered were pleural air leak (37.5%) bleeding (25%) infection (25%) and recurrence (2%). Overall morbidity from pleural decortication was seen in 16 patients, and there was no mortality.Conclusions: The most common reason for pleural decortication is still empyema thoracis secondary to infection in the developing countries. Tuberculosis is still the most common cause leading to fibrothorax requiring pleural decortication followed closely by pyogenic lung infections and trauma.

Rezultati postoperativnog preživljavanja pacijenata sa pleuralnim malignim mezoteliomom stadijuma I-II u endemskom području

Introduction: The accepted treatment option for malignant pleural mesothelioma (MPM) is multimodality treatment including surgery, chemotherapy and radiotherapy. In this study, we aimed to evaluate the results of patients who underwent surgical resection for multimodality treatment due to MPM at our clinic between July 2015 and October 2019. Method: The results of 13 patients who underwent surgical treatment for MPM in our clinic were evaluated retrospectively. Patients' demographic structure, regions where they live, symptom presentation, disease localization, biopsy diagnosis, type of surgical treatment, choice of neoadjuvant or adjuvant chemotherapy, postoperative complications and survival outcomes were evaluated. Results: The mean survival time was 19.6 months. Six patients were still under follow-up. One patient whose postoperative pathology was reported as mixed type had the worst survival with 13 months and the best survival was 32 months in the patient who underwent postoperative hyperthermic chemotherapy with pleural decortication. Four patients died due to local recurrence and general condition disorder, and two patients died after peritonitis carcinomatosis and ascites. Conclusion: Epitheloid type multimodality treatment and intrapleural hyperthermic chemotherapy may be a good choice in patients with the stage I and II malignant mesothelioma without surgical comorbidity

Safety and complications of medical thoracoscopy in the management of\xa0pleural diseases

BackgroundMedical thoracoscopy is considered an overall safe procedure, whereas numbers of studies focus on complications of diagnostic thoracoscopy and talc poudrage pleurodesis. We conduct this study to evaluate the safety of medical thoracoscopy in the management of pleural diseases and to compare complications in different therapeutic thoracoscopic procedures.MethodsA retrospective study was performed in 1926 patients, 662 of whom underwent medical thoracoscopy for diagnosis and 1264 of whom for therapeutic interventions of pleural diseases. Data on complications were obtained from the patients, notes on computer system, laboratory and radiographic findings. Chi-square test was performed to compare categorical variables and Fisher’s exact test was used for small samples.ResultsThe mean age was 51 ± 8.4 (range 21–86) years and 1117 (58%) were males. Diagnostic procedure was taken in 662 (34.4%) patients, whereas therapeutic procedure was taken in 1264 (65.6%) patients. Malignant histology was reported in 860 (44.6%) and 986 (51.2%) revealed benign pleural diseases. Eighty patients (4.2%) were not definitely diagnosed and they were considered as unidentified pleural effusion. One patient died during the creation of artificial pneumothorax, and the causes of death were supposed as air embolism or an inhibition of phrenic motoneurons and circulatory system. Complication of lung laceration was found in six patients (0.3%) and reexpansion pulmonary edema was observed in two patients (0.1%). Higher incidence of prolonged air leak was observed in bulla electrocoagulation group, in comparison with pleurodesis group. Moreover, pain and fever were the most frequently complications in pleurodesis group and cutaneous infection in entry site was the most frequently reported complication in pleural decortication of empyema group.ConclusionsMedical thoracoscopy is generally a safe and effective method, not only in the diagnosis of undiagnosed pleural effusions, but also in the management of pleural diseases. Mastering medical thoracoscopy well, improving patient management after the procedure and attempts to reduce the occurrence of post-procedural complications are the targets that physicians are supposed to achieve in the future.

Residual Pleural Space after Lung Resection

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.

The approach to the spontaneous pneumothorax in period of compulsory public service

Aim: There is air in the pleural space without an external effect in the case of spontaneous pneumothorax, and it is important in terms of treatment, clinic, and underlying diseases in thoracic surgery. In this study, it was aimed to present the approach to the patients with spontaneous pneumothorax in the period of compulsory public service. Material and method: The patients who were treated with spontaneous pneumothorax between June 2017 and January 2018 in our clinic were included in this study. Gender, age, smoking status, type of treatment and length of hospital stay were recorded. Result: 18 patients (2 female, 16 male) were included in the study. Eleven of the patients (61.1%) were smoking. Surgical treatment was applied to 7 (38.8%) of the patients. As a surgical approach, videothoracoscopic wedge resection and partial pleural decortication in 5 patients, videothoracoscopic bulla ligation and partial pleural decortication in 1 patient and thoracotomy bulla ligation in 1 patient were applied. Ten patients were treated with tube thoracostomy and one patient was treated with nasal oxygen. Complications did not occur in the patients. Conlusion: Spontaneous pneumothorax is a disease requiring urgent diagnosis and treatment. The purpose of the treatment is to provide the lung totally expanded and to prevent recurrence of pneumothorax. Tube thoracostomy is usually the first approach, but we recommend that the videothoracoscopic surgery can be used in the conditions of the public hospital because of its advantages for the patients who have surgical indications.

WHEN PSEUDO BECOMES REAL: CORONARY VEIN GRAFT PSEUDOANEURYSM COMPLICATING VIDEO-ASSISTED THORACOSCOPIC SURGERY

Video-assisted thoracoscopic surgery (VATS) with pleural decortication is a commonly performed procedure for patients with empyema and fibrosis. An 80-year-old female with coronary artery disease with left internal mammary bypass to left anterior descending artery and vein graft to left circumflex

Iatrogenic pleural empyema caused byPropionibacterium acnes

Propionibacterium acnes is one of the commensals living on the human skin and glands, implicated mainly in acnes, but seldom in deep infection. Pleural empyema is rarely complicated with closed thoracostomy. We experienced 1 case of empyema caused by P. acnes after pleural biopsy and closed thoracostomy through a percutaneous pigtail catheter. A 79-year-old man was admitted for cough, purulent sputum and shortness of breath. Three weeks ago, closed thoracostomy and pleural biopsy were performed to confirm a diagnosis for his recurrent pleural effusion. He had increased amount of right pleural effusion. Through the pigtail cathe ter, pleural effusion was removed. Gram-positive rods were observed in Gram stain, but not cultured. By 16S rRNA analysis, P. acnes was confirmed as the pathogen. His empyema was repeatedly treated with antibiotics, fibrolysis and irrigation. Pleural decortication was recommended. We report the first case of empyema with P. acnes in Korea, possibly complicated with closed thoracostomy pro cedures. (Allergy Asthma Respir Dis 2019;7:61-64)

Pneumothorax tuberculeux : prise en charge diagnostique et thérapeutique

Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. A retrospective multicentric and descriptive study including 65patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. The mean age was 37.8years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15months for susceptible TB and was at least 12months for resistant TB (4cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6cases. Mean time to surgery was 171days. Six patients had pleural decortication associated with pulmonary resection in 4cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately.

The Effects of Pleural Decortication on Respiratory Functions of The Patients Having Pleural Empyemas

The Effects of Pleural Decortication on Respiratory Functions of The Patients Having Pleural Empyemas

The benefits of digital chest drainage in pleural decortication in thoracic empyema. Prospective, randomised, control trial

Abstract Background Prolonged air leak after pleural decortication is one of the most frequent complications. Objective The aim of this study is to compare the effects of prolonged air leak between the digital chest drainage (DCD) system and the classic drainage system in patients with empyema class IIB or III (American Thoracic Society classification) in pleural decortication patients. Material and methods A total of 37 patients were enrolled in a prospective randomised control trial over one year, consisting of 2 blinded groups, comparing prolonged air leak as a main outcome, the number of days until removal of chest drain, length of hospital stay and complications as secondary outcomes. Results The percentage of prolonged air leak was 11% in the DCD group and 5% in the classic group (p = 0.581); the mean number of days of air leak was 2.5±1.8 and 2.4±2.2, respectively (p = 0.966). The mean number of days until chest tube removal was 4.5±1.8 and 5.1±2.5 (p = 0.41), the length of hospital stay was 7.8±3.7 and 8.9±4.0 (p = 0.441) and the complication percentages were 4 (22%) and 7 (36%), respectively (p = 0.227). Discussion In this study, no significant difference was observed when the DCD was compared with the classic system. This was the first randomised clinical trial for this indication; thus, future complementing studies are warranted.

Infectious pleural effusion status and treatment progress.

Pleural cavity infection continuously seriously threatens human health with continuous medical progress. From the perspective of pathophysiology, it can be divided into three stages: exudative stage, fibrin exudation and pus formation stage, and organization stage. Due to the pathogenic bacteria difference of pleural cavity infection and pulmonary infection, it is very important for disease treatment to analyze the bacteria and biochemical characteristics of the infectious pleural effusion. Most prognoses of patients have been relatively good, while for some patients, the complicated parapneumonic effusion or empyema could be evolved. Antibiotic treatment and sufficient drainage are the foundation for this treatment. No evidence can support the routine use of a fibrin agent. However, it has been reported that the plasminogen activator and deoxyribonuclease can be recommended to be applied in the pleural cavity. In case of failure on conservative medical treatment, operative treatment can be applied such as thoracoscopy and pleural decortication. According to the clinical characteristics of these patients, it is a key to research prognosis, as well as early evaluation and stratification, in the future.

Clinical history and surgical management of parapneumonic empyema what is the role of video-assisted thoracoscopic surgery (VATS)?

Pleural empyema represents a frequent disease, characterized sometimes by blurred and unspecific signs or symptoms but requiring timely diagnosis in order to plan the most appropriate therapeutic regimen. Several classifications have proposed and the most widely used is the American Thoracic Society (ATS) one, according to increasing severity depending of the extent of disease. Different therapeutic strategies such as conservative regimens (antibiotic therapy and chest tube placement) and surgical one (empyemectomy with pleural decortication) were applied. To this date, minimally invasive surgery is assuming an important role in the management of empyema and represents the gold standard in stage II disease and a valid alternative to the classical approach in stage III in absence of a complete obliteration of the pleural space. Aim of the work is to define, through a comprehensive review of literature, the role of video-assisted thoracoscopic surgery according to limits and advantages compared to conservative methods and the most invasive surgical approaches.

Surgical Treatment of Pleural Empyema - Our Results.

To analyze the results of the surgical treatment in patients with empyema treated at Clinic for thoracic surgery. In the retrospective study we analyzed 234 patients with empyema which were treated at the Clinic for Thoracic Surgery in 5 year period (2011-2015). The mean age of the patients was 51.94 years. They were treated with pleural drainage, decortications or thoracoplasty. With pleural drainage were treated 165/234 (70.51%) patients, of which successfully were finished 124/165 (75.15%), but 41/165 (24.85%) were indicated after the decortications. A total of 108/234 (46.15%) were treated with decortications from which, primary decortications were indicated in 67/234 (28.63%) patients. 5/234 (2.14%) patients were treated with thoracoplasty - 3 of the patients with decortications and 2 with primary indicated thoracoplasty according to the local findings, long term untreated empyema and bad general condition. The Mean hospitalization was 17.4 days, of which 13.4 days after surgery. In the group with primary drainage it was detected a lethal outcome in 7/124 (5.64%) patients, 5/105 (4.76%) in the group with decortications and 2/5 (40%) in the group with thoracoplasty. Early detection of the parapneumonic effusion and the adequate treatment will prevent the appearance of empyema. If the empyema is detected it is necessary as early as possible to start the treatment with minimally invasive pleural drainage. In earlier stages it is possible to use less invasive decortications, using VATS than the open thoracotomy decortication which is more extensive surgical intervention.