Introdution: Thoracic empyema is the presence of pus in the pleural cavity. Mostly it complicates cases of pneumonia, trauma or it is iatrogenic. Initial approach includes chest drain and empirical antibiotic therapy. The use of fibrinolytics is controversial, according to the experience of each center. Current surgical options include thoracoscopy (VATS) or thoracotomy. Mortality rate is 6 to 24%. Methods: Review of medical records of patients admitted from 2006 to 2010 with diagnosis of empyema. Results: 44 patients had thoracic empyema, mean age 60.5 years, 70% male.75% had infectious causes (pneumonia-68%), chest trauma 7% and 18% iatrogenic. Microbial agent was isolated in 25%. 30 patients used medical therapy only; 6 died. Fibrinolytics were not used. 14 patients underwent surgical treatment (1 VATS and 13 thoracotomy), 78,6%men, mean age 53,5 years. 57% related to infection, 29% iatrogenic and 14% trauma. They had a shorter hospitalization period (26 vs 31 days) and a shorter period of chest drain tube (17 vs 20 days) but there were no differences between co-morbidities, pleural effusion volume, isolated bacteria or antibiotic therapy. Conclusions: As expected, empyemas mainly complicate infections. Patients were younger in the operated group, associated to more cases of trauma or iatrogenic empyemas, but there were no other differences between groups. Thoracotomy was the principal method of surgical treatment. Since there was only 1 VATS we can't compare the efficacy and complications of both surgical approaches, although it's use is increasing in many centers. Surgical approach should be considered early to reduce hospitalization time and improve outcome. Mortality rate was between expected values and related to patient's co-morbidities.
Ladeira et al. (Thu,) studied this question.
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