Chronic tuberculous empyema: relationships between preoperative CT findings and postoperative improvement measured by pulmonary function testing

Comparison of closed-chest drainage with rib resection closed drainage for treatment of chronic tuberculous empyema

Background

This study aimed to compare the efficacy of closed-chest drainage with rib resection closed drainage of chronic tuberculous empyema.

Methods

This retrospective study reviewed 86 patients with tuberculous empyema in Shanghai Pulmonary Hospital from August 2010 to November 2015. Among these included patients, 22 patients received closed-chest drainage, and 64 patients received rib resection closed drainage.

Results

The results showed that after intercostal chest closed drain treatment, 2 (9.09%) patients were recovery, 13 (59.09%) patients had significantly curative effect, 6 (27.27%) patients had partly curative effect, and 1 (4.55%) patient had negative effect. After treatment of rib resection closed drainage, 9 (14.06%) patients were successfully recovery, 31 (48.44%) patients had significantly curative effect, 19 (29.69%) patients had partly curative effect, and 5 (7.81%) patients had negative effect. There was no significant difference in the curative effect (P>0.05), while the average catheterization time of rib resection closed drainage (130.05±13.12 days) was significant longer than that (126.14±36.84 days) in course of intercostal chest closed drain (P<0.05).

Conclusions

This study had demonstrated that closed-chest drainage was an effective procedure for treating empyema in young patients. It was less invasive than rib resection closed drainage and was associated with less severe pain. We advocated closed-chest drainage for the majority of young patients with empyema, except for those with other diseases.

Computed tomographic modeling before and after treatment for posttraumatic empyema: early decortication is superior to catheter drainage

BACKGROUND

Posttraumatic empyema is relatively unusual. There are little data comparing the results of various interventions, and no data that have documented the restoration of lung volumes.

METHODS

We compared patients with posttraumatic empyema who were treated with catheter drainage or decortication. Computed tomographic scans of the chest were obtained before and after treatment, and computed tomographic modeling was used to determine the change in lung volumes after each intervention.

RESULTS

From 2006 to 2010 there were 478 patients admitted after sustaining chest trauma and 25 (5%) developed an empyema. The definitive treatment was decortication in 15 patients (60%) and chest tube or catheter drainage in 10 (40%). Four patients (16%) initially treated with chest tubes later required decortication. The overall complication rate was 33% for decortication and 100% for catheters. There was no significant difference in days of mechanical ventilation (catheter-median 0, SD±13 days; decortication-median 10, SD±12 days; p=0.6), total length of stay (catheter-median 15, SD±36 days; decortication-median 27, SD±17 days; p=0.9), and intensive care unit days (catheter-median 6, SD±19 days; decortication-median 15, SD±17 days; p=0.5). After chest tube drainage, the lung volume increased on average by 751 cubic centimeters (range, 99 to 1,982 cc). After decortication, the lung volume increased on average by 1,519 cc (range, 616 to 2,916, p=0.02).

CONCLUSIONS

Decortication for posttraumatic empyema results in higher postoperative lung volumes than catheter drainage and has a lower complication rate. Decortication is more effective in restoring full pulmonary capacity in the treatment of posttraumatic empyema.

[Pulmonary decortication: value of lung function recovery]

PURPOSE

Based on the experience in the thoracic surgery unit at Hôpital Militaire d'Instruction Mohammed-V in Rabat, this study analyses the indications as well as the results of pulmonary decortication.

MATERIALS AND METHODS

Twenty-five cases of pulmonary decortication were examined over a period of 5 years ranging from January 2002 to December 2006. The aetiology of chronic pyothorax was dominated by non tubercular causes. The clinical symptomatology mainly involved fever and dyspnoea (48% and 44% respectively). Pachypleuritis, collapse of the lung and pleural effusion account for most of the lesions found on the thoracic imaging. Surgery was indicated after failure in the medical treatment after four months on the average.

RESULTS

The respiratory function was assessed in 20 patients three months after the intervention. The improvement in the spirometry was good in 85% of the cases (n=17), was not highly satisfactory in 10% of the cases (n=2) and a deterioration was noted in 5% of the cases (n=1). This unfavourable evolution was correlated with the tubercular aetiology and the poor state of the pulmonary parenchyma.

CONCLUSION

Non tubercular causes, early diagnosis and absence of parenchymatous lesion seem to be predictive factors of good results after decortication.

The value of computed tomography for predicting empyema-associated malignancy

OBJECTIVE

To determine the value of computed tomography (CT) scanning in detecting associated malignancy in patients with chronic empyema.

METHODS

Two radiologists retrospectively reviewed CT scans of 112 consecutive patients with chronic empyema and arrived at a consensus about the findings. Among these patients, 6 were confirmed by pathology evaluation to have empyema-associated malignancy (EAM), including 4 lymphomas. The CT scans were evaluated for the presence of the following findings: a mass in the empyema sac; mass involvement of the extrapleural fat, chest wall, rib, and lung; bulging of the empyema sac; nodular pleural thickening; empyema involvement of the mediastinal pleura; presence of lung nodules (>1 cm); and mediastinal lymph node enlargement. The association between the CT findings and the EAM was analyzed with the Fisher exact test. A multiple logistic regression analysis was used to determine the predictive variables for EAM. Sensitivity, specificity, and positive predictive value were calculated for each finding.

RESULTS

All CT findings, except rib involvement and bulging of empyema sac, were significantly associated with EAM (P<0.05). The finding of the presence of a mass, extrapleural fat, and mediastinal involvement showed relatively high sensitivity (100%, 67%, 67%, respectively) and specificity (81%, 87%, 91%, respectively). A bulging of the empyema sac and nodular pleural thickening showed 100% sensitivity, but low specificity (39% and 44%, respectively). Findings from the multiple logistic regression analysis revealed that the presence of a mass and empyema of the mediastinal pleura were significant variables associated with EAM (P<0.05).

CONCLUSIONS

Although many CT findings are associated with EAM, most showed either low positive predictive value or low sensitivity. A variety of CT findings should be considered when evaluating CT image-based detection of EAM.