[Pleural empyema: surgical treatment]

Abstract

Pleural empyema runs in three stages, if untreated. Because it produces uncharacteristic signs, specific diagnosis and adequate treatment is often delayed. The treatment should be early, according to the stage and adapted to the given situation. Expenditure and morbidity of treatment are the higher the longer it is delayed. In the exudative stage 1, drainage--if necessary combined with antibiotic administration--is likely to be successful. In the fibrinous-purulent stage 3, often not clearly demarked from the other stages, video-assisted thoracoscopy (VATS) in its various forms provides the best therapeutic prerequisite. It makes it possible to open all cavities and free pleural layers from the, usually fibrinous or fibrosing, contents. Furthermore, VATS allows targeted drainage placement as essential precondition of effective irrigation. The definitive stage 3 of organization requires the technically demanding empyema excision or decortication.