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The Egyptian Journal of Bronchology
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The role of medical thoracoscopy in the management of empyema

Egyptian Journal of Bronchology volume 13, pages 55–62 (2019)Cite this article

Abstract

Background

Empyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality.

Aim

The aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema.

Patients and methods

This study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface.

Results

The present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study.

Conclusion

MT is a simple, safe, minimally invasive, and effective modality in the management of empyema.

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Authors and Affiliations

  1. Department of Chest Disease, Faculty of Medicine, Benha University, 13511, Benha, Egypt

    Ahmad G. El Gazzar, Mohammad A. E. El-Mahdy, Gehan F. Al Mehy & Asmaa El Desoukey Mohammad MBBCh (Assistant lecturer)

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  1. Ahmad G. El Gazzar
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  2. Mohammad A. E. El-Mahdy
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  3. Gehan F. Al Mehy
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  4. Asmaa El Desoukey Mohammad MBBCh
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Correspondence to Asmaa El Desoukey Mohammad MBBCh.

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El Gazzar, A.G., El-Mahdy, M.A.E., Al Mehy, G.F. et al. The role of medical thoracoscopy in the management of empyema. Egypt J Bronchol 13, 55–62 (2019). https://doi.org/10.4103/ejb.ejb_44_18

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  • DOI: https://doi.org/10.4103/ejb.ejb_44_18

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