Thoracoscopic management of empyema thoracis

Abstract

Appropriate management of empyema thoracis is dependent upon a secure diagnosis of the etiology of empyema and the phase of development. Minimal access surgery using video-assisted thoracoscopy (VATS) is one of many useful techniques in treating empyema. Complex empyema requires adjunctive treatment in addition to VATS.

Keywords: Empyema; video-assisted thoracoscopy.

Figure 1

Standard AP chest X-ray depicting an elevated diaphragm with loculation of the left pleural space

Figure 2

CT scan of the same patient in Figure 1, demonstrating loculation and septation of the pleural space, indicating a phase II empyema

Figure 3

Empyemectomy specimen

Figure 4

Initial thoracoscopic view of VATS decortication of a phase II (fibrinopurulent) empyema

Figure 5

Bronchopleural fistula and empyema following right pneumonectomy for Histoplasmosis and broncholithiasis

Figure 6

Post-resection empyema treated with Eloesser flap

Figure 7

Wound vacuum placed following Eloesser flap

Figure 8

Right middle lobe lung abscess and pleural empyema

Figure 9

Thoracoscopic view of patient in Figure 8. There is an incidental azygous lobe (double arrows panel a) and an abscess in the right middle lobe (arrow, panel b)