Abstract Background Determining when to remove a chest tube in empyema remains debated, particularly when daily drainage exceeds traditional thresholds. While conventional practice favors removal when output is 100-150 mL/day, individualized and clinically-guided decisions are increasingly warranted and supported. Case Presentation A 62-year-old man with PMH of Type I Gaucher disease, chronic thrombocytopenia, HTN, and obesity presented with a three-week history of productive cough and fatigue. Chest CT revealed a multiloculated right-sided pleural effusion with adjacent area of necrosis in the right lower lobe FIGURE-1. Pleural fluid was pinkish-brown and turbid with pH 6.8, WBC 259,000/µL (91% neutrophils), RBC 278,000/µL, LDH 7500 U/L, and protein 3.9 g/dL. Findings were consistent with a complicated exudative pleural effusion. Etiology was likely anerobic empyema 150 mL/day for chest tube removal, several studies suggest that sterile and non-purulent serous output may not necessitate prolonged drainage if radiographic improvement and patient recovery are evident. Prolonged tube placement can increase pain, infection risk, complication risk, and hospital stay. In this patient, early removal despite moderate output resulted in full resolution and no recurrence. Individualized, multidisciplinary decision-making—incorporating pleural fluid characteristics, patient comorbidities, and dynamic imaging assessment—can optimize outcomes and reduce unnecessary interventions in complex pleural infections. This abstract is funded by: None
Meka et al. (Fri,) studied this question.
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