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Postgraduate Education Corner: CHEST IMAGING AND PATHOLOGY REVIEW |

Interventional Management of Pleural Infections

John E. Heffner, MD, FCCP; Jeffrey S. Klein, MD, FCCP; Christopher Hampson, MD
Author and Funding Information

Affiliations: From the Department of Medicine (Dr. Heffner), Providence Portland Medical Center, Oregon Health and Science Center, Portland, OR; and Fletcher Allen Health Care (Drs. Klein and Hampson), University of Vermont College of Medicine, Burlington, VT.

Correspondence to: John E. Heffner, MD, Providence Portland Medical Center, 5050 NE Hoyt St., Suite 540, Portland, OR 97213; e-mail: John_heffner@mac.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(4):1148-1159. doi:10.1378/chest.08-2956
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Pleural infections represent an important group of disorders that is characterized by the invasion of pathogens into the pleural space and the potential for rapid progression to frank empyema. Previous epidemiologic studies have indicated that empyema is increasing in prevalence, which underscores the importance of urgent diagnosis and effective drainage to improve clinical outcomes. Unfortunately, limited evidence exists to guide clinicians in selecting the ideal drainage intervention for a specific patient because of the broad variation that exists in the intrapleural extent of infection, presence of locules, comorbid features, respiratory status, and virulence of the underlying pathogen. Moreover, many patients experience delays in both the recognition of infected pleural fluid and the initiation of appropriate measures to drain the pleural space. The present review provides an update on the pathogenesis and interventional therapy of pleural infections with an emphasis on the unique role of image-guided drainage with small-bore catheters.

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