Background: Pleural empyema can be subdivided into 3 stages: exudative, fibro-purulent or multiloculated and organizing. In the absence of clear septation, simple chest tube drainage could be the standard treatment, whereas patients with clear septation would require a form of thoracoscopy. Aims and objectives: The aim of this study was to report our experience and analyze the efficacy and safety of medical thoracoscopy in patients with multiloculated and organizing empyema. Methods: We performed a retrospective study reviewing all files patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011. Results: A total of 48 patients with effusion were treated by medical thoracoscopy, of whom 41 (85.4%) had empyema. Empyema was multiloculated in 24 patients (58.5%) and organizing in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%) but this response was different in the different stages of empyema. All the 9 patients with free flowing fluid were treated successfully with medical thoracoscopy, 22 of the 24 patients with multiloculated empyema (91.7%) were treated successfully and only 4 of 8 patients with organizing effusion (50%). Conclusions: Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring a video-assisted thoracic surgery or open surgical decortication.
Ravaglia et al. (Thu,) studied this question.