Minimally invasive treatment of thoracic empyema

Background: The present study was undertaken to assess the efficacy of serial thoracocentesis and saline irrigation for the treatment of pleural empyema, for post pneumonia versus other causes. Methods: Included were 42 consecutive patients with complicated pleural effusion (n=14) or frank pus (n=28) at diagnostic thoracocentesis, of mean age 57.5+/-23.7 years. Pneumonia was the probable cause in 29 patients, other causes (principally thoracic surgery) in 13. In addition to antibiotics in all patients, ultrasonography-guided serial suction thoracocentesis with saline irrigation was used as therapy of first choice in most patients: 28/29 post-pneumonia and 9/13 non-pneumonic empyema. Exceptions were mainly on the grounds of preceding thoracic surgery. Results: Success rate was 86% in the post-pneumonia group, with no crossovers to more invasive therapy. Mortality was 14%, none empyema-related. Treatment was less successful in the non-pneumonia group at 69%, with a 56% crossover rate from thoracocentesis due to therapy failure. Mortality was 23%. Conclusions: Results indicate that timely, minimally invasive therapy is a feasible modality far the management of post-pneumonia thoracic empyema. Serial thoracocentesis was less suitable for the treatment of non-pneumonic empyema, however, particularly if it was a surgical complication. More invasive strategies seem preferable in such cases.