Title: Empyema Thoracis: A Clinical Study of 15 Cases in Tertiary Care Center
Authors: Dr Rakesh Digambar Waghmare, Dr Rakhi Ashok Gosavi
DOI: https://dx.doi.org/10.18535/jmscr/v5i11.182
Abstract
Background: Empyema thoracis, defined as a collection of pus in the pleural space
Aims: To study the clinical, microbiological and treatment outcomes obtained by ICD care in tertiary care hospital.
Methodology: A prospective study conducted in tertiary care hospital in 15 patients diagnosed as empyema thoracis
Results: In the study, male-to-female ratio was 2:1. Their mean age was 47.86 years. The commonest symptoms at presentation were cough, seen in 14 patients (93.33%).Sputum was positive for AFB by ZN stain in 6 patients (40%) out of 15 in present study. Pseudomonas were isolated most frequently from empyema fluid in 6 patients (40%), followed by sterile pus in 4 (26.66%). Patient was treated with tube thoracostomy connected to an underwater seal drainage and systemic antibiotics, with this approach complete expansion of the lung seen in 8 patients (53.33%), while 3 patients (20%) had only partial expansion, 2 (13.33%) patients had empyema with bronchopleural fistula (BPF) and referred to the cardiovascular thoracic surgery department for decortication.
Conclusion: It can be concluded from the above study that, all patients of empyema have chronic morbidity and Intercostal drainage with under water seal was the treatment of choice with most acceptable outcome. If the procedure is performed with appropriate care and adequate post ICD care is provided then chances of developing complications are minimal and most of them are easily curable.
Keywords: Intercostal drainage tube, Empyema with bronchopleural fistula (BPF).
References
- Adams F. The genuine works of Hippocrates, Baltimore: William and Wilkins Company; 1939;51 – 2.
- C. Hewett, “Thoracentesis: the plan of continuous aspiration,” The British Medical Journal, vol. 1, no. 793, p. 317, 1876.
- Jess P, Brynitz S, Friis Møller A. Mortality in thoracic empyema. Scand J Thorac Cardiovasc Surg 1984;18:85-7.
- Hutter JA, Harari D, Braimbridge MV. The management of empyema thoracis by thoracoscopy and irrigation. Ann Thorac Surg 1985;39:517-20.
- Varkey B, Rose HD, Kutty CP, Politis J. Empyema thoracis during a ten- year period. Analysis of 72 cases and comparison to a previous study (1952 to 1967). Arch Intern Med 1981;141:1771-6.
- Lemmer JH, Botham MJ, Orringer MB. Modern management of adult thoracic empyema. J Thorac Cardiovasc Surg 1985;90:849-55.
- Storm HK, Krasnik M, Bang K, Frimodt-Møller N. Treatment of pleural empyema secondary to pneumonia: thoracocentesis regimen versus tube drainage. Thorax 1992;47:821–824.
- Geha AS. Pleural empyema. Changing etiologic, bacteriologic, and therapeutic aspects. J Thorac Cardiovasc Surg. 1971; 61:626-35.
- Sherman MM, Subramanian V, Berger RL. Managment of thoracic empyema. Am J Surg. 1977;133:474-9.
- Tandon RK, Misra OP. Clinicopathological study of thoracis empyema and evaluation of its surgical treatment. Indian J Chest Dis. 1974;16:21–30.
- Kamat SR, Kadalkar SS, Maydeo DV, Walimbe S, Kulkarni KG, Hanmantgad RR, et al. Aprospective study of one hundred cases of chronic empyema in Bombay. Lung India 1985;3:15-9.
- Emerson JD, Boruchow IB, Daicoff GR, Bartley TD, Wheat MW Jr. Empyema. J Thorac Cardiovasc Surg. 1971;62:967-72.
- Bhatnagar R, Maskell NA. Treatment of complicated pleural effusions in 2013. Clin Chest Med. 2013;34:47-62.
- Gupta A, Dutt N , Patel N.The different treatment modalities of pyopneumothorax – A study of 50 cases. International journal of Medical Science and Public Health,2013,vol 2,issue 3,609-12.
- Bryant LR, Chicklo JM, Crutcher R, Danielson GK, Malette WG, Trinkle JK. Management of thoracic empyema. J Thorac Cardiovasc Surg. 1968;55:850- 8.
- Tandon RN, Khanna BK. Management of Tuberculous Empyema. Indian J Tuberc. 959;7:95-99.