0
Editorials |

Paradigm Shift in Empyema Management

Anthony P.C. Yim, MD, FCCP
Author and Funding Information

Affiliations: Hong Kong, China 
 ,  Chief, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital.

Correspondence to: Professor Anthony P.C. Yim, Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR, China; e-mail: yimap@cuhk.edu.hk



Chest. 1999;115(3):611-612. doi:10.1378/chest.115.3.611
Text Size: A A A
Published online

Extract

Empyema thoracis has been recognized as a disease entity since the time of Hippocrates and historically has been associated with high mortality. During World War I, the overall empyema mortality rate among US military forces was 61%.1

There are few conditions in which management depends as much on the timing of treatment in the course of the disease. Although this has been recognized for a long time, the importance of timely intervention in empyema management has not been emphasized enough. Over 30 years ago, the American Thoracic Society described three stages in the natural course of empyema, namely the exudative, fibrinopurulent, and organizing phases.2 While the free-flowing exudative phase can be adequately treated by tube drainage and antibiotics, the transition to the fibrinopurulent phase is often associated with the development of thick pus and multiple loculations, rendering simple drainage and antibiotics inadequate. Surgical intervention is indicated at this stage to adequately evacuate the infected material and to create a unified space for drainage. If this is not done, the empyema will progress to the stage of fibrotic encasement of the lung, which requires more complex surgical procedures for infection control and eradication.3 Decortication and suction drainage usually result in lung re-expansion, otherwise pleurocutaneous window, intrathoracic transposition of skeletal muscle, or thoracoplasty remain life-saving but now uncommon options for treating a closed-space infection.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Topics

empyema

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543