J.Jpn. Surg. Soc.. 105(12): 751-756, 2004

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Feature topic

PATHOGENESIS AND TREATMENT OF CHRONIC EMPYEMA

In chronic empyema (CE), thickened pleura, collapsed chest wall, and the accumulation of purulent fluid in the thoracic cavity are typical findings. Patients complaints of symptoms with bronchopleural fistula (BPF). On the other hand, there is another type of CE in which the pleural space expands progressively to shift the neighboring lungs, mediastinum, and diaphragm. This type of CE is considered to be chronic expanding hematoma (Reid et al.) occurring in the thoracic cavity.
In the empyemic cavity, mycobacterial infection is found approximately in 20-30% of cases, pyogenic bacillus or fungus in about 40%, but the cavity is aseptic in other 30-40%.
Although the fundamental treatment procedures include decortication and pleuropneumonectomy, the method of muscle or omental plombage to manage dead space or BPF are far superior functionally in intractable CE. Recently, the methods of plastic and reconstructive surgery have been used to utilize the muscle or omentum more effectively. The classic thoracoplasty procedure should not be undertaken unnecessarily to avoid additional deterioration of respiratory function. Additionally, it should be remembered that malignant lymphoma occurs frequently in the empyemic chest wall.

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