Chest
Clinical Investigations: PLEURAL DISEASETreatment of Sonographically Stratified Multiloculated Thoracic Empyema by Medical Thoracoscopy
Section snippets
Study Design and Patients
We performed a retrospective case chart review in three departments of pulmonology (Basel, Switzerland; Brescia, Italy; and Montana, Switzerland). From 1989 to 2003, all files of patient referred for multiloculated pleural empyema and treated by medical thoracoscopy were reviewed. Empyema was defined as frank pus on thoracocentesis with or without positive smear and bacteriologic culture findings, or pH < 7.2 with signs of infection. The diagnosis had to be confirmed by chest radiography, and
RESULTS
A total of 127 patients with multiloculated pleural empyema were included in the study, of whom 73% (93 of 127 patients) were male. Mean age was 58 ± 18 years (range 9 to 93 years). The etiology of multiloculated pleural empyema is given inTable 1. In 60 of 127 patients (47%), a microbiological diagnosis could be made (Table 2). The patients received antibiotic treatment prior to medical thoracoscopy for a median of 8 days (range, 0 to 73 days; n = 42). In 91% of cases, the duration of
DISCUSSION
Our study shows that multiloculated pleural empyema stratified by chest ultrasonography can safely and successfully be treated with medical thoracoscopy. In our 127 patients, no deaths and no chronic morbidity related to empyema were observed.
Like most of the published studies on pleural empyema derived from a case series,3 patient selection and treatment biases cannot be excluded in this retrospective study. Over the study period, advances in the medical treatment of empyema were made
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