Parapneumonic pleural effusion, pleural empyema: medical and surgical aspects

The following are essential for prophylaxis and treatment of empyema: antibiotic therapy for pneumonia, based on susceptibility results; early detection of parapneumonic effusions (decubitus radiograph, sonograph); immediate diagnostic thoracocentesis if a parapneumonic effusion is large, increasing despite antibiotic therapy, if it is associated with clinical deterioration or if empyema is suspected; assessment of the stage of parapneumonic effusion or empyema (clinical signs, sonography, CT, laboratory parameters); immediate therapeutic thoracocentesis of frank empyema, in loculated empyema fibrinolytic agents may be used; early surgical intervention if conservative management fails; complete thoracoscopic decortication, if necessary open thoracotomy to assure complete reexpansion of the lung.