• Journal of Chest Surgery
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• v.37 no.2
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• pp.188-192
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• 2004

Treatment of huge chronic tuberculous empyema with cardiopulmonary dysfunction. Drainage of empyemal space by closed thoracostomy in chronic tuberculous empyema is generally contraindicated because of the possibility of empyema necessitatis and ascending infection. But in case that serious cardiopulmonary dysfunction is present, drainage of empyema and decompression is necessary. We experienced a case in which chronic tuberculous empyema was big enough to cause mediastinal shifting and cardiopulmonary failure. Immediate drainage of pleural cavity with tube thoracostomy was performed. Afterward, pleuropneumonectomy was done following cyclic irrigation for one month. The patient had successful postoperative course without any evidence of complication or relapse of infection.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.795-798
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• 2008

A 50 year old male patient was admitted due to fever and left upper-quadrant abdominal pain. He had a history of previous treatment for pulmonary TB and splenectomy due to plastic anemia. A large peritoneal abscess with connection to a chronic left side tuberculous empyema thoracis was diagnosed on admission. Chest CT also revealed a soft issue lesion on the left anterior chest wall. Staged drainage of the peritoneal lesion followed by left side pleuropneumonectomy with chest wall resection was performed. The pathologic studies showed a high grade sarcoma of the chest wall.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.68-72
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• 2002

Congenital bronchoesophageal fistula is a rare anomaly that may cause fatal complications if it goes unnoticed for many years. This anomaly may have various symptoms such as respiratory infections, coughing bouts when eating or drinking and even hemoptysis. Surgical resection is the treatment of choice and is definitive in almost cases. We report a case of type I congenital bronchoesophageal fistula misdiagnosed as chronic empyema thoracis with literature review.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.914-919
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• 1997

We analyzed the changes of pulmonary function after decortication i 33 patients with chronic empyema thoracis. In 11 patients of them, scintigraphic lung perfusion scan were performed. The results are as follows; 1, Forced expiratory volume in one second(FEVI) increased from 2.30 L/sec to 2.65 L/sec after decorticati on (p = 0.008) . 2. In patients under 20 years-old, PEV 1 increased significantly(p=0.001). 3. In patients who had tuberculosis empyema thoracis, FEVI increased significantly(p=0.008). The post-operative FEVI increased significantly 24 months later(p=0.013). 4. Te post-operative FEV1 increased significantly 24 months later(p=0013). 5. Perfusion and FEV1 of diseased lung changed from 21.5% to 26.9%(p=0.046) and 0.56 L/sec to 0.78 L/sec(p=0.071) after decortication respectively and perfusion of non-diseased lung changed 78.4% to 72.9% after decortication(p=0.042).

• Proceedings of the KTCVS Conference
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• 1996.10a
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• pp.109-109
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• 1996

• Journal of Chest Surgery
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• v.40 no.11
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• pp.765-769
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• 2007

Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

• Journal of the Korean Society of Radiology
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• v.84 no.1
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• pp.304-310
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• 2023

Solitary fibrous tumors (SFTs) commonly arise from the pleura and are mostly benign. However, they may develop anywhere in the body, and 10%-30% are malignant. Classically, SFTs appear as solitary enhancing masses, and bilateral presentation is extremely rare. In this case, an 88-year-old male presented with back pain and a history of chronic tuberculous empyema. Imaging studies revealed bilateral paravertebral masses with aggressive radiologic features, which were speculatively presumed as thoracic malignancies in association with chronic empyema. Herein, we report a unique case of bilateral paravertebral malignant SFTs that were accurately diagnosed with a CT-guided coaxial needle biopsy.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1063-1069
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• 1998

Background: Multi-loculated empyema makes treatment difficult, and more so when thoracentesis or chest tube drainage fails. Materials and methods: From December 1991 to December 1997, we performed closed rib resectional drainage for 18 cases of loculated empyema on the fibrinopurulent or early chronic phase. Results: Surgery was performed on patients with loculated empyema complaining of persistent symptoms due to failure of treatment by thoracentesis(8 cases) or chest tube drainage(10 cases). Predisposing factors of empyema were pneumonia in 13 cases, clotted hemothorax in 3 cases, cholecystectomy, and tuberculous pleurisy in 1 case. Causal organisms were cultured in 8 cases(42.1%), and methicillin-resistant staphylococcus aureus was found in 3 cases, pseudomonas aeruginosa in 2 cases, and enterococcus aerogens, α-hemolytic streptococcus, and acinetobacter baumannii were found in 1 case. Size of loculations was various, and computed chest tomogram showed multiple loculations of empyema numbering 1∼4(mean 1.78±1.00). Operating time was relatively short, about 55∼140 mins(mean 102.8±30.8). All toxic symptoms including fever disappeared postopratively and general conditions improved very quickly in all patients. Length of chest tube indwelling time and hospital stay after surgery were 3∼42 days(mean 11.4±11.5) and 6∼36 days(mean 12.9±8.1), respectively. Complications of prolonged drainage occurred in 2 cases and no death occurred. There were no recurrences and chest x-rays taken 3∼6 months after surgery showed normal findings in 14 cases and slight pleural thickening in 4 cases. Conclusions: Closed rib resectional drainage requires very simple techniques and has excellent outcomes and little complications, therefore, we think that it is the choice of operation for patients with loculated empyema on the fibrinopurulent or early chronic phase.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.571-574
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• 1993

We present a rare case of malignant lymphoma developing from the wall of chronic empyema thoracis. A 54-year old man with a 35 year history of tuberculosis empyema was admitted due to right chest pain and general weakness for 2 months. Under the impression of chronic empyema thoracis with destroyed right lung and tumor on posterior costophrenic sulcus, pleuropneumonectomy including tumor was performed as a single procedure through a right thoracotomy. The tumor arose from the thickened pleura, and it was histologically and immunologically diffuse large cell[non-cleaved] B-cell non-Hodgkin`s lymphoma [NHL]

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1128-1131
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• 1997

Injuries to versa cave continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior versa java perforation by a chest rainage tube in the patient with post-operative chronic empyema thoracic. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL & suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.