Safety and efficacy of medical thoracoscopy in the management of loculated thoracic empyema

Abstract

Background: Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment. Aim of study: To evaluate the safety and efficacy of medical thoracoscopy in the management of loculated thoracic empyema. Methods: This study was conducted at chest department, Al-Azhar Faculty of medicine Al-Housein University Hospital in the period from October 2015 to August 2016. On 30 patients, 22 males and 8 females with age ranging between 20 and 74 years (mean age 48.3 ± 15.5 years). Diagnosed as loculated thoracic empyema (27 patients) or empyema failed to respond to medical treatment or chest tube drainage (3 patients) were undergo medical thoracoscopy. Results: A total of 30 patients with loculated empyema were managed by medical thoracoscopy. Histopathological finding of study sample were (Non-specific inflammation 23.3%, Suppurative exudative reaction 16.7%, Tuberculous caseating granuloma 23.3%, Lymphocytic Inflammation 6.7%, fibrino purulent inflammation 13.3%, adenocarcinoma 3.3, Pleural fibrosis and thickening 10% and Pleural calcification, ossification, pleurisy 3.3%). Medical thoracoscopy was considered successful without further intervention in 26 of 30 patients (86.7%), 3 patients (10%) clinically improved but lung did not expanded and referred for thoracic surgery for decortication and 1 patient (3.3%) need for surgery to fistula closure. Conclusions: Our study confirms that loculated pleural empyema could safely and successfully be treated by medical thoracoscopy.