PURPOSE: Post-traumatic empyema (PTE) may cause significant morbidity and mortality. PTE resulting from ruptured lung abscess has not previously been described.
METHODS: From 9/01 to 3/08, 125 consecutive empyema patients were retrospectively reviewed for ruptured lung abscesses confirmed at surgery. Data abstracted included: demographics, injury mechanism, thoracic and abdominal injuries, chest tube duration, pathogens isolated, operation performed, length of stay, and outcome.
RESULTS: 20 patients were identified. Average age, GCS and ISS were 37.5 (±12.7) years, 8.6 (± 4.9) and 28.8 (±12.5) respectively. 17(85%) sustained chest trauma, 11 with penetrating injury. Six (30%) had concomitant abdominal injuries. Specific thoracic injuries included: pneumothorax 14, hemothorax 11, rib fractures 11, pulmonary contusion 8, ruptured diaphragm 2 and 1 flail chest. Preoperatively, 90% had central lines, 80% were ventilated on average 18.2(±10.9) days, 20% had intracranial pressure monitoring, 15% required vasoactive medication and all had chest tubes, average duration 7.7(±6.2) days. 19 required thoracotomy; one had VATS. All underwent decortication, pleurectomy and pulmonary wedge resection. 48 pathogens were isolated: 13 Gram positive cocci, 17 Gram negative rods, 6 Gram positive rods, 11 anaerobes and 2 fungi. 62% were polymicrobial. There were 2(10%) operative and no late deaths. All 18 survivors were cured of lung abscess. Average duration of antibiotic therapy was 19.6(±12.8) days. Post-operative chest tube duration was 7.3(±4.2) days. Average hospital and ICU length of stay were 35.5(±17.4) and 28.4 (± 19.5) days respectively. On discharge, only 2(11%) required mechanical ventilation. Two patients had recurrent empyema, one treated by catheter drainage and one underwent re-operative thoracotomy.
CONCLUSION: Ruptured lung abscesses were found in 16% of PTE. Patients with ruptured lung abscesses are severely injured, critically ill, and infected with diverse pathogens and polymicrobial flora. A combination of aggressive operative management and appropriate antibiotic treatment yields excellent results.
CLINICAL IMPLICATIONS: Ruptured lung abscess should be considered as an etiology of post-traumatic empyema.
DISCLOSURE: Mayur Narayan, No Financial Disclosure Information; No Product/Research Disclosure Information