Minimally invasive treatment of thoracic empyema

Thorac Cardiovasc Surg. 1999 Apr;47(2):77-81. doi: 10.1055/s-2007-1013115.


Background: The present study was undertaken to assess the efficacy of serial thoracocentesis and saline irrigation for the treatment of pleural empyema, for post-pneumonia versus other causes.

Methods: Included were 42 consecutive patients with complicated pleural effusion (n=14) or frank pus (n=28) at diagnostic thoracocentesis, of mean age 57.5 +/- 23.7 years. Pneumonia was the probable cause in 29 patients, other causes (principally thoracic surgery) in 13. In addition to antibiotics in all patients, ultrasonography-guided serial suction thoracocentesis with saline irrigation was used as therapy of first choice in most patients: 28/29 post-pneumonia and 9/13 non-pneumonic empyema. Exceptions were mainly on the grounds of preceding thoracic surgery.

Results: Success rate was 86% in the post-pneumonia group, with no crossovers to more invasive therapy. Mortality was 14%, none empyema-related. Treatment was less successful in the non-pneumonia group at 69%, with a 56% crossover rate from thoracocentesis due to therapy failure. Mortality was 23 %.

Conclusions: Results indicate that timely, minimally invasive therapy is a feasible modality for the management of post-pneumonia thoracic empyema. Serial thoracocentesis was less suitable for the treatment of non-pneumonic empyema, however, particularly if it was a surgical complication. More invasive strategies seem preferable in such cases.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Empyema, Pleural / etiology
  • Empyema, Pleural / mortality
  • Empyema, Pleural / surgery*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures* / mortality
  • Paracentesis / adverse effects
  • Pleural Effusion / complications
  • Pneumonia, Bacterial / complications
  • Survival Rate
  • Thoracic Surgical Procedures / methods*
  • Thoracic Surgical Procedures / mortality
  • Treatment Outcome