AI Article Synopsis

  • Thoracic empyema treatment requires quick diagnosis and intervention, focusing on the disease's cause, patient condition, and disease stage.
  • For acute cases, video-assisted thoracoscopic surgery is preferred if tube drainage fails, while chronic cases may need more invasive methods like decortication or pleural space obliteration.
  • There’s no one-size-fits-all treatment, as decisions largely depend on expert opinions and institutional practices, emphasizing personalized approaches for each patient.

Article Abstract

Thoracic empyema remains challenging for thoracic surgeons. The principles of empyema treatment are early diagnosis and early treatment. Decision-making involves a triad consisting of the etiology of empyema, general condition of the patient and stage of disease. For acute empyema, early surgical intervention, such as video-assisted thoracoscopic debridement, is recommended when conventional chest tube drainage has failed. Radical treatments of chronic empyema include 1 removal of the empyema space (decortication with or without lung resection) and 2 obliteration of the pleural space with muscle flaps or omentum flaps, or by thoracoplasty. Decortication is the procedure of choice for patients with re-expandable underlying lung. For patients who are not eligible for the above-mentioned radical treatment, open-window thoracostomy can be considered. The current attitudes show that the present concepts are based mainly on expert opinion. No exclusive sequence of procedures leading to a uniformly predictable successful outcome is available. Individualized approaches can be recommended based on institutional practice and local protocols.

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