Thoracic empyema: Current opinions in medical and surgical management

Current Opinion in Pulmonary Medicine

Volumn 16, Issue 3, 2010, Pages 194-200

  Lee, Simon F ^a   Lawrence, David ^a   Booth, Helen ^b   Morris Jones, Stephen ^a   MacRae, Bruce ^a   Zumla, Alimuddin ^a,c  

^a UNIVERSITY COLLEGE LONDON HOSPITALS   (United Kingdom)

^b UCLH   (United Kingdom)

^c UNIVERSITY COLLEGE LONDON   (United Kingdom)

Author keywords

Decortication; Drainage; Empyema; Fibrinolysis; Pleural effusion; Thoracocentesis; Videoassisted thoracoscopic surgery

Indexed keywords

ANTIBIOTIC AGENT; ANTICOAGULANT AGENT; FIBRINOLYTIC AGENT; TUBERCULOSTATIC AGENT;

CLINICAL TRIAL; DIAGNOSTIC IMAGING; HUMAN; PLEURA EMPYEMA; PLEURA FLUID; POSTOPERATIVE CARE; REVIEW; THORACIC CAVITY; THORACOCENTESIS; TUBERCULOUS EMPYEMA;

ADULT; AGED; ANTI-BACTERIAL AGENTS; COMBINED MODALITY THERAPY; DRAINAGE; EMPYEMA, PLEURAL; FEMALE; FOLLOW-UP STUDIES; HUMANS; MALE; MIDDLE AGED; RANDOMIZED CONTROLLED TRIALS AS TOPIC; RISK ASSESSMENT; SEVERITY OF ILLNESS INDEX; THORACIC SURGERY, VIDEO-ASSISTED; TREATMENT OUTCOME;

EID: 77951093824     PISSN: 10705287     EISSN: 15316971     Source Type: Journal    
DOI: 10.1097/MCP.0b013e32833883f5     Document Type: Review

References (115)

1. Christopoulou-Aletra H, Papavramidou N. 'Empyemas' of the thoracic cavity in the Hippocratic Corpus. Ann Thorac Surg 2008; 85:1132-1134.
2. Chen W, Lin Y, Liang S, et al. Hospital-acquired thoracic empyema in adults: a 5-year study. South Med J 2009; 102:909-914.
3. Liang SJ, Chen W, Lin Y, et al. Community-acquired thoracic empyema in young adults. South Med J 2007; 100:1075-1080.
4. Ferguson AD, Prescott RJ, Selkon JB, et al. The clinical course and management of thoracic empyema. Q J Med 1996; 89:285-289.
5. Roxburgh CSD, Youngson GG, Townend JA, Turner SW. Trends in pneumonia and empyema in Scottish children in the past 25 years. Arch Dis Child 2008; 93:316-318.
6. Finley C, Clifton J, Fitzgerald JM, Yee J. Empyema: an increasing concern in Canada. Can Respir J 2008; 15:85-89.
7. Bender JM, Ampofo K, Sheng X, et al. Parapneumonic empyema deaths during past century, Utah. Emerging Infect Dis 2009; 15:44-48.
8. Li ST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics 2010; 125:26-33.
9. Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev 2008:CD002312.
10. Heffner JE, Klein JS, Hampson C. Interventional management of pleural infections. Chest 2009; 136:1148-1159.
11. Davies H, Davies R, Davies C. British Thoracic Society: management of pleural infection - draft guidelines. BTS; 29 July 2009. pp. 1-39.
12. Schiza S, Siafakas NM. Clinical presentation and management of empyema, lung abscess and pleural effusion. Curr Opin Pulm Med 2006; 12:205-211.
13. Gopi A, Madhavan SM, Sharma SK, Sahn SA. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007; 131:880-889.
14. Molnar TF. Current surgical treatment of thoracic empyema in adults. Eur J Cardiothorac Surg 2007; 32:422-430.
15. Qureshi NR, Gleeson FV. Imaging of pleural disease. Clin Chest Med 2006; 27:193-213.
16. Chen KY, Liaw YS, Wang HC, et al. Sonographic septation: a useful prognostic indicator of acute thoracic empyema. J Ultrasound Med 2000; 19:837-843.
17. Chiu C, Wong K, Huang Y, et al. Echo-guided management of complicated parapneumonic effusion in children. Pediatr Pulmonol 2006; 41:1226-1232.
18. Smolikov A, Smolyakov R, Riesenberg K, et al. Prevalence and clinical significance of pleural microbubbles in computed tomography of thoracic empyema. Clin Radiol 2006; 61:513-519.
19. Gill RR, Gerbaudo VH, Jacobson FL, et al. MR imaging of benign and malignant pleural disease. Magn Reson Imaging Clin N Am 2008; 16:319- 339; x.
20. Peltola V, Ruuskanen O, Svedström E. Magnetic resonance imaging of lung infections in children. Pediatr Radiol 2008; 38:1225-1231.
21. Weingardt JP, Guico RR, Nemcek AAJ, et al. Ultrasound findings following failed, clinically directed thoracenteses. J Clin Ultrasound 1994; 22:419-426.
22. Grogan DR, Irwin RS, Channick R, et al. Complications associated with thoracentesis. A prospective, randomized study comparing three different methods. Arch Intern Med 1990; 150:873-877.
23. Raptopoulos V, Davis LM, Lee G, et al. Factors affecting the development of pneumothorax associated with thoracentesis. AJR Am J Roentgenol 1991; 156:917-920.
24. Kohan JM, Poe RH, Israel RH, et al. Value of chest ultrasonography versus decubitus roentgenography for thoracentesis. Am Rev Respir Dis 1986; 133:1124-1126.
25. Barnes TW, Morgenthaler TI, Olson EJ, et al. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound 2005; 33: 442-446.
26. Diacon AH, Brutsche MH, Solè r M. Accuracy of pleural puncture sites: a prospective comparison of clinical examination with ultrasound. Chest 2003; 123:436-441.
27. Shankar S, Gulati M, Kang M, et al. Image-guided percutaneous drainage of thoracic empyema: can sonography predict the outcome? Eur Radiol 2000; 10:495-499.
28. Chen C, Chen W, Chen H, et al. Transthoracic ultrasonography in predicting the outcome of small-bore catheter drainage in empyemas or complicated parapneumonic effusions. Ultrasound Med Biol 2009; 35:1468-1474.
29. Maier A, Domej W, Anegg U, et al. Computed tomography or ultrasonically guided pigtail catheter drainage in multiloculated pleural empyema: a recommended procedure? Respirology 2000; 5:119-124.
30. Chen H, Yu Y, Tu C, et al. Ultrasound in peripheral pulmonary air-fluid lesions. Color Doppler imaging as an aid in differentiating empyema and abscess. Chest 2009; 135:1426-1432.
31. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax 2005; 60 (Suppl 1):i1-i21.
32. Calder A, Owens CM. Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol 2009; 39:527-537.
33. Jaffe A, Calder AD, Owens CM, et al. Role of routine computed tomography in paediatric pleural empyema. Thorax 2008; 63:897-902.
34. Sethuraman KN, Duong D, Mehta S, et al. Complications of tube thoracostomy placement in the emergency department. J Emerg Med 2008 [Epub ahead of print].
35. Davies HE, Merchant S, McGown A. A study of the complications of small bore 'Seldinger' intercostal chest drains. Respirology 2008; 13:603-607.
36. LandayM, OliverQ, Estrera A, et al. Lung penetration by thoracostomy tubes: imaging findings on CT. J Thorac Imaging 2006; 21:197-204.
37. Hogan MJ, Coley BD. Interventional radiology treatment of empyema and lung abscesses. Paediatr Respir Rev 2008; 9:77-84; quiz 84.
38. Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment. Chest 2009; 135:1315-1320.
39. Jones PW, Moyers JP, Rogers JT, et al. Ultrasound-guided thoracentesis: is it a safer method? Chest 2003; 123:418-423.
40. Froudarakis ME. Diagnostic work-up of pleural effusions. Respiration 2008; 75:4-13.
41. Sahn SA. The value of pleural fluid analysis. Am J Med Sci 2008; 335:7-15.
42. Foster S, Maskell N. Bacteriology of complicated parapneumonic effusions. Curr Opin Pulm Med 2007; 13:319-323.
43. Mishra EK, Rahman NM. Factors influencing the measurement of pleural fluid pH. Curr Opin Pulm Med 2009; 15:353-357.
44. Karaman I, Erdog? an D, Karaman A, Cakmak O. Comparison of closed-tube thoracostomy and open thoracotomy procedures in the management of thoracic empyema in childhood. Eur J Pediatr Surg 2004; 14:250-254.
45. Heffner JE, Brown LK, Barbieri C, DeLeo JM. Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis. Am J Respir Crit Care Med 1995; 151:1700-1708.
46. Santotoribio JD, Leó n-Justel A, Delgado-Pecell?́n C, Guerrero JM. What are the biochemical parameters of pleural fluid that best identify parapneumonic effusions? Ann Clin Biochem 2009; 46:176-177.
47. Chan M, Chang K, Chao W, et al. Evaluation of a new inflammatory molecule (triggering receptor expressed on myeloid cells-1) in the diagnosis of pleural effusion. Respirology 2007; 12:333-338.
48. Bishara J, Goldberg E, Ashkenazi S, et al. Soluble triggering receptor expressed on myeloid cells-1 for diagnosing empyema. Ann Thorac Surg 2009; 87:251-254.
49. Jiménez D, D?́az G, Garc?́a-Rull S, et al. Routine use of pleural fluid cultures. Are they indicated? Limited yield, minimal impact on treatment decisions. Respir Med 2006; 100:2048-2052.
50. Lahti E, Mertsola J, Kontiokari T, et al. Pneumolysin polymerase chain reaction for diagnosis of pneumococcal pneumonia and empyema in children. Eur J Clin Microbiol Infect Dis 2006; 25:783-789.
51. Foroulis CN, Gerogianni I, Kouritas VK, et al. Direct detection of Clostridium sordellii in pleural fluid of a patient with pneumonic empyema by a broadrange 16S rRNA PCR. Scand J Infect Dis 2007; 39:617-619.
52. Obando I, Arroyo LA, Sá nchez-Tatay D, et al. Molecular typing of pneumococci causing parapneumonic empyema in Spanish children using multilocus sequence typing directly on pleural fluid samples. Pediatr Infect Dis J 2006; 25:962-963.
53. Porcel JM, Ruiz-Gonzá lez A, Falguera M, et al. Contribution of a pleural antigen assay (Binax NOW) to the diagnosis of pneumococcal pneumonia. Chest 2007; 131:1442-1447.
54. Ploton C, Freydiere AM, Benito Y, et al. Streptococcus pneumoniae thoracic empyema in children: rapid diagnosis by using the Binax NOW immunochromatographic membrane test in pleural fluids. Pathol Biol (Paris) 2006; 54:498-501.
55. Sauer S, Kliem M. Mass spectrometry tools for the classification and identification of bacteria. Nat Rev Microbiol 2010; 8:74-82.
56. Le Monnier A, Carbonnelle E, Zahar J, et al. Microbiological diagnosis of empyema in children: comparative evaluations by culture, polymerase chain reaction, and pneumococcal antigen detection in pleural fluids. Clin Infect Dis 2006; 42:1135-1140.
57. Hooper CE, Lee YCG, Maskell NA. Interferon-gamma release assays for the diagnosis of TB pleural effusions: hype or real hope? Curr Opin Pulm Med 2009; 15:358-365.
58. Krenke R, Safianowska A, Paplinska M, et al. Pleural fluid adenosine deaminase and interferon gamma as diagnostic tools in tuberculosis pleurisy. J Physiol Pharmacol 2008; 59 (Suppl 6):349-360.
59. Mishra OP, Kumar R, Ali Z, et al. Evaluation of polymerase chain reaction and adenosine deaminase assay for the diagnosis of tuberculous effusions in children. Arch Dis Child 2006; 91:985-989.
60. Porcel JM. Tuberculous pleural effusion. Lung 2009; 187:263-270.
61. Koegelenberg CF, Bolliger CT, Theron J, et al. A direct comparison of the diagnostic yield of ultrasound-assisted Abrams and Tru-cut needle biopsies for pleural tuberculosis. Thorax 2009 [Epub ahead of print].
62. Carboni GL, Fahrner R, Gazdhar A, et al. Comparison of procalcitonin and CrP in the postoperative course after lung decortication. Eur J Cardiothorac Surg 2008; 33:777-780.
63. Chen SC, Chen W, Hsu WH, et al. Role of pleural fluid C-reactive protein concentration in discriminating uncomplicated parapneumonic pleural effusions from complicated parapneumonic effusion and empyema. Lung 2006; 184:141-145.
64. Horsley A, Jones L, White J, Henry M. Efficacy and complications of smallbore, wire-guided chest drains. Chest 2006; 130:1857-1863.
65. Keeling AN, Leong S, Logan PM, Lee MJ. Empyema and effusion: outcome of image-guided small-bore catheter drainage. Cardiovasc Intervent Radiol 2008; 31:135-141.
66. Rahman NM, Maskell NA, Davies et al. The relationship between chest tube size and clinical outcome in pleural infection. Chest 2009 [Epub ahead of print].
67. Davies HE, Rahman NM, Parker RJ, Davies RJO. Use of indwelling pleural catheters for chronic pleural infection. Chest 2008; 133:546-549.
68. Tokuda Y, Matsushima D, Stein GH, Miyagi S. Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis. Chest 2006; 129:783-790.
69. Bouros D, Tzouvelekis A, Antoniou KM, Heffner JE. Intrapleural fibrinolytic therapy for pleural infection. Pulm Pharmacol Ther 2007; 20:616-626.
70. Cameron R, Davies HR. Intra-pleural fibrinolytic therapy versus conservative management in the treatment of parapneumonic effusions and empyema. Cochrane Database Syst Rev 2004:CD002312.
71. Khalil BA, Corbett PA, Jones MO, et al. Less is best? The impact of urokinase as the first line management of empyema thoracis. Pediatr Surg Int 2007; 23:129-133.
72. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med 2006; 174:221-227.
73. Aydog? an M, Aydog? an A, Ozcan A, et al. Intrapleural streptokinase treatment in children with empyema. Eur J Pediatr 2008; 167:739-744.
74. Maskell NA, Davies CWH, Nunn AJ, et al. U. K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med 2005; 352:865-874.
75. Misthos P, Sepsas E, Konstantinou M, et al. Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg 2005; 28:599-603.
76. Zhu Z, Hawthorne ML, Guo Y, et al. Tissue plasminogen activator combined with human recombinant deoxyribonuclease is effective therapy for empyema in a rabbit model. Chest 2006; 129:1577-1583. (Pubitemid 43894989)
77. Dikensoy O, Zhu Z, Na MJ, et al. Intrapleural heparin or heparin combined with human recombinant DNase is not effective in the treatment of empyema in a rabbit model. Respirology 2006; 11:755-760. (Pubitemid 44581440)
78. Rahman NM, Maskell N, Davies CWH, et al. Primary result of the second Multicentre Intrapleural Sepsis (MIST2) Trial; randomised trial of intrapleural TPA and DNase in pleural infection. Thorax 2009; 64 (Suppl 4):A1.
79. Davies CWH, Gleeson FV, Davies RJO. BTS guidelines for the management of pleural infection. Thorax 2003; 58 (Suppl 2):ii18-28.
80. Luján M, Gallego M, Rello J. Optimal therapy for severe pneumococcal community-acquired pneumonia. Intensive Care Med 2006; 32:971-980. (Pubitemid 43952713)
81. Ng T, Ryder BA, Maziak DE, Shamji FM. Treatment of postpneumonectomy empyema with debridement followed by continuous antibiotic irrigation. J Am Coll Surg 2008; 206:1178-1183.
82. Bagan P, Boissier F, Berna P, et al. Postpneumonectomy empyema treated with a combination of antibiotic irrigation followed by videothoracoscopic debridement. J Thorac Cardiovasc Surg 2006; 132:708-710.
83. Engel ME, Matchaba PT, Volmink J, Corticosteroids for tuberculous pleurisy. Cochrane Database of Systematic Reviews 2007: CD001876.
84. Tacconi F, Pompeo E, Fabbi E, Mineo TC. Awake video-assisted pleural decortication for empyema thoracis. Eur J Cardiothorac Surg 2009; 37:594-601.
85. Katlic MR. Video-assisted thoracic surgery utilizing local anesthesia and sedation. Eur J Cardiothorac Surg 2006; 30:529-532.
86. Edwin F, Frimpong-Boateng K. Is video-assisted thoracoscopic surgery really superior to open decortication for empyema thoracis? [eComment]. Interact Cardiovasc Thorac Surg 2009; 9:78.
87. Casali C, Storelli ES, Di Prima E, Morandi U. Long-term functional results after surgical treatment of parapneumonic thoracic empyema. Interact Cardiovasc Thorac Surg 2009; 9:74-78.
88. Cardillo G, Carleo F, Carbone L, et al. Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication. Eur J Cardiothorac Surg 2009; 36:914-918.
89. Drain AJ, Ferguson JI, Sayeed R, et al. Definitive management of advanced empyema by two-window video-assisted surgery. Asian Cardiovasc Thorac Ann 2007; 15:238-239.
90. Chan DTL, Sihoe ADL, Chan S, et al. Surgical treatment for empyema thoracis: is video-assisted thoracic surgery 'better' than thoracotomy? Ann Thorac Surg 2007; 84:225-231.
91. St Peter SD, Tsao K, Harrison C, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg 2009; 44:106-111.
92. Bishay M, Short M, Shah K, et al. Efficacy of video-assisted thoracoscopic surgery in managing childhood empyema: a large single-centre study. J Pediatr Surg 2009; 44:337-342.
93. Cremonesini D, Thomson AH. How should we manage empyema: antibiotics alone, fibrinolytics, or primary video-assisted thoracoscopic surgery (VATS)? Semin Respir Crit Care Med 2007; 28:322-332.
94. Sonnappa S, Jaffe A. Treatment approaches for empyema in children. Paediatr Respir Rev 2007; 8:164-170.
95. Potaris K, Mihos P, Gakidis I, Chatziantoniou C. Video-thoracoscopic and open surgical management of thoracic empyema. Surg Infect (Larchmt) 2007; 8:511-517.
96. Dzielicki J, Korlacki W. The role of thoracoscopy in the treatment of pleural empyema in children. Surg Endosc 2006; 20:1402-1405.
97. Aziz A, Healey JM, Qureshi F, et al. Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect (Larchmt) 2008; 9:317-323.
98. Cohen E, Weinstein M, Fisman DN. Cost-effectiveness of competing strategies for the treatment of pediatric empyema. Pediatrics 2008; 121: e1250-e1257.
99. Shah SS, DiCristina CM, Bell LM, et al. Primary early thoracoscopy and reduction in length of hospital stay and additional procedures among children with complicated pneumonia: results of a multicenter retrospective cohort study. Arch Pediatr Adolesc Med 2008; 162:675-681.
100. Shah SS, Ten Have TR, Metlay JP. Costs of treating children with complicated pneumonia: a comparison of primary video-assisted thoracoscopic surgery and chest tube placement. Pediatr Pulmonol 2009. [Epub ahead of print]
101. Kang DWW, Campos JRMD, Andrade Filho LDO, et al. Thoracoscopy in the treatment of pleural empyema in pediatric patients. J Bras Pneumol 2008; 34:205-211.
102. Li ST, Gates RL. Primary operative management for pediatric empyema: decreases in hospital length of stay and charges in a national sample. Arch Pediatr Adolesc Med 2008; 162:44-48.
103. Shah SS, Ten Have TR, Metlay JP. Costs of treating children with complicated pneumonia: a comparison of primary video-assisted thoracoscopic surgery and chest tube placement. Pediatr Pulmonol 2010; 45:71-77.
104. Wozniak CJ, Paull DE, Moezzi JE, et al. Choice of first intervention is related to outcomes in the management of empyema. Ann Thorac Surg 2009; 87:1525-1530;discussion 1530-1531.
105. Kalfa N, Allal H, Lopez M, et al. Thoracoscopy in pediatric pleural empyema: a prospective study of prognostic factors. J Pediatr Surg 2006; 41:1732-1737.
106. Medford ARL, Awan YM, Marchbank A, et al. Diagnostic and therapeutic performance of video-assisted thoracoscopic surgery (VATS) in investigation and management of pleural exudates. Ann R Coll Surg Engl 2008; 90:597-600.
107. Barbetakis N, Paliouras D, Asteriou C, Tsilikas C. The role of video-assisted thoracoscopic surgery in the management of tuberculous empyemas [eComment]. Interact Cardiovasc Thorac Surg 2009; 8:337-338.
108. Kerti C, Miron I, Cozma GV, et al. The role of surgery in the management of pleuropulmonary tuberculosis: seven years' experience at a single institution. Interact Cardiovasc Thorac Surg 2009; 8:334-337; discussion 337.
109. Pappalardo E, Laungani A, Demarche M, Erpicum P. Early thoracoscopy for the management of empyema in children. Acta Chir Belg 2009; 109:602-605.
110. Fuller MK, Helmrath MA. Thoracic empyema, application of video-assisted thoracic surgery and its current management. Curr Opin Pediatr 2007; 19:328-332.
111. Suchar AM, Zureikat AH, Glynn L, et al. Ready for the frontline: is early thoracoscopic decortication the new standard of care for advanced pneumonia with empyema? Am Surg 2006; 72:688-692; discussion 692-693.
112. Solaini L, Prusciano F, Bagioni P. Video-assisted thoracic surgery in the treatment of pleural empyema. Surg Endosc 2007; 21:280-284.
113. Kokoska ER, Chen MK. Position paper on video-assisted thoracoscopic surgery as treatment of pediatric empyema. J Pediatr Surg 2009; 44:289-293.
114. Schneiter D, Cassina P, Korom S, et al. Accelerated treatment for early and late postpneumonectomy empyema. Ann Thorac Surg 2001; 72:1668-1672.
115. Schneiter D, Grodzki T, Lardinois D, et al. Accelerated treatment of postpneumonectomy empyema: a binational long-term study. J Thorac Cardiovasc Surg 2008; 136:179-185.