• Journal of Chest Surgery
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• v.13 no.1
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• pp.26-33
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• 1980

The incidence of the empyema thoracis has been drastically reduced with the advent of antimicrobial drugs. Empyema thoracis is however still dealt with one of major problems in thoracic surgery because of difficulties in the management of associated bronchopleural fistula. During the period of January 1975 to June 1979, 145 patients of empyema thoracis were treated in the Department of Thoracic Surgery, Busan National University Hospital. This reports dealed especially with the incidence, etiology and management of chronic empyema thoracis with B.P.F. and estimated the results of intercostal myoplasty. The results: 1 ] Among 145 empyema thoracis patients, 33 patients [22.7%] had bronchopleural fistula. 2] Male predominated in general with the ratio of 4:1 and in empyema thoracis with B.P.F. male predominance was further more prominent with the ratio of 10:1. Peak incidence of chronic empyema thoracis lay on 3rd and 4th decade. 3] The most common causation of empyema thoracis was pneumonia [77.3%] in children and tuberculosis [48.8%] in adult. 4] The most common causative organism of empyema thoracis was staphylococcus aureus [52.5%]. 5] Among 40 cases of resection for pulmonary tuberculosis, 4 cases developed empyema thoracis with B.P.F. [10%], and resection for another underlying pathology was 2.1%. 6] In contrast to good prognosis of acute empyema thoracis, chronic empyema thoracis with B.P.F. was improved only 66.6% of cases. 81.5% of chronic empyema without B.P.F. were cured completely. 7] Intercostal myoplasty were performed in 21 cases of empyema thoracis with B.P.F. and of which 15 cases showed that fistula were closed. 8] The over all mortality rate in empyema thoracis was 8.7%. The mortality rate of chronic empyema thoracis with and without B.P.F. was 15.2% and 5.3% respectively.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.593-597
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• 1992

The bronchopleural fistula[BPF] due to bronchial stump disruption after pneumonec-tomy has remained one of the most dreadful complications to now. The management of the BPF with empyema thoracis are still therapeutic dilemma even though a various surgical methods for the control of BPF with or without empyema thoracis. We have experienced the successful treatment of BPF & empyema thoracis with transsternal transpericardial approach. The patient was a 54 years old male who was taken left pneumonectomy at W. Medical Center at sept, 19th. 1991. He was suffered from the BPF R empyema thoracis and so was transferred to our hospital at Nov. 19th. 1991. We treated the patient with transsternal transpericardial bronchial closure for BPF, and put clagett procedure for empyema thoracis in 2 weeks. We think this kind of surgical techniques is one of the relatively simple and effective method for the control of BPF and empyema thoracis.

• Journal of Chest Surgery
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• v.24 no.6
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• pp.555-559
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• 1991

Post-pneumonectomy empyema thoracis is an uncommon, but very serious problem. Early diagnosis & adequate drainage followed by thoracoplasty and or myoplasty are very important principles for the management of the empyema thoracis & will enable patient to recover from the toxic effects. During the period of January, 1985 to December, 1990, 13 patients with post-pneumonectomy empyema thoracis were treated in the department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine. There were 10 males % 3 females ranging from 31 years to 79 years of age. The occurrence ratio of left to right side was 8: 5. The underlying pathologic lesions of empyema thoracis were pulmonary tuberculosis[7], lung ca. [2] pneumothorax[2], lung abscess[1] pneumonia[1]. We treatment procedure for post-pneumonectomy empyema thoracis were open window thoracostomy in 10 cases, Clagett procedures in 2 cases, one thoracoplasty, and two cases of Clagett procedures followed by open window thoracostomy in one cases.

• 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.26 no.8
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• pp.613-619
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• 1993

As developing surgical techniques and postoperative cares, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other type of pulmonary resection, but a postpneumonectomy complication is a life-threatening serious problem if it occurred. We performed one hundred twenty-five cases of pneumonectomy for treatment of various causes of pulmonary diseases in Kosin Medical College during about ten years, and we experienced 41 cases of postoperative complications in 29 patients, so we analyzed them. The most common complication is an empyema thoracis in 13 cases[10.4%], of which one case combined with bronchopleural fistula died on early postoperative day. Of them except one case, the early postoperative empyema thoracis[within 30 days] were 6 cases, and the late postoperative empyema thoracis[above 30 days] were 6 cases. The main etiologic pathogens were a staphylococcus in early postoperative empyema and a streptococcus in late postoperative empyema, but the most cases were mixed infections with pseudomonas, klebsiella, acinectobacter, and candida. The treatment of postoperative empyema thoracis were that 4 cases were treated with open drainage using chest tube, 7 cases with Clagett`s operation, and 1 case with thoracoplasty. The next common complication was a postoperative serious respiratory insufficiency in 7 cases. And the other complications were massive postoperative bleeding in 5 cases, of which 2 cases advanced to occurrence of postoperative empyema thoracis, and wound disruption in 4 cases, cardiac arrhythmia in 3 cases, contralateral pneumothorax and pneumonia in each of 2 cases, esophagopleural fistula in 1 case. The postoperative deaths were 9 cases[7.2%] of 125 cases, the causes of death were respiratory insufficiency in 6 cases, sepsis in 2 cases, and cardiac arrhythmia in 1 case.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.271-275
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• 1992

One hundred forty patients with empyema thoracis were managed under the general anesthesia at the Seoul National University Hospital between 1980 and 1990. The patients, who were managed by thoracentesis or intercostal tube drainage alone, were excluded in this study. There were 92 males and 48 females, ranging from 8 to 80 years of age. Underlying pathologic lesions of empyema thoracis were primary bronchopulmonary infection [84%], postoperative empyema[11%], malignancy, paragonimiasis, spontaneous pneumothorax and so on. A single causal organism was isolated only in 17 patients[the most common being staphylococcus aureus, pseudomonas, & streptacoccus pneumoniae], multiple organism in 31, and no growth in 32. Surgical treatment modalities were decortication[75], pleuropneumonectomy[30], decortication with lobectomy[10], empyemectomy[9], open drainage[13], Clagett procedure [6], thoracoplasty with or without muscle transposition[9]. Hospital mortality were in 2 cases[1.4%], one empyema related and the other nonrelated. In this study, bacteriologic findings were nonspecific and often polymicrobial. We conclude that early thoracotomy can be lifesaving in the presence of a benign clinical course.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.566-571
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• 1990

The Bronchial stump disruption in bronchopleural fistula with empyema thoracis after pneumonectomy has remained one of the most dreaded complications of thoracic surgery. Management of chronic bronchopleural fistula still poses a therapeutic dilemma in spite of various surgical techniques that have been attempted to control this complication. Only recently, transsternal transpericardial approach for repair of the postpneumonectomy bronchopleural fistula has been utilized in some cases. The patient was a 31 year-old woman who was admitted to our hospital on August 18th, 1989 due to right postpneumonectomy bronchopleural fistula with empyema thoracis for 5 years since she had undergone right pneumonectomy due to pulmonary tuberculosis at E-hospital in 1984. Transsternal transpericardial closure of the fistula was employed and then the thoracic catheter was removed two months later, after the empyema cavity was sterilized by the Clagett method. So, we think this surgical technique is a relatively simple and effective method to the control of chronic postpneumonectomy bronchopleural fistula with empyema thoracis.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.65-70
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• 1987

Empyema thoracis following pneumonia, pulmonary tuberculosis, trauma and surgical procedures continues to be a source of major morbidity and mortality. We retrospectively reviewed the hospital records of 330 patients [child:87, adult243] treated for empyema thoracis at Catholic Medical Center between 1964 and 1986. The causes of empyema in these patients were as follows: pneumonia [C***:66%, A***:30%], pulmonary tuberculosis [C:2%, A:20%], lung abscess [C:3%, A:5%], postoperative complication [C:0%, A:13%], trauma [C:1%, A:4%] and unknown origin [C:23%, A:17%]. Three patients in this series died of sepsis from necrotizing pneumonia. Staphylococcus [29.3%], Streptococcus [8.8%], E. coli [8%], Mycobacterium tuberculosis [7.9%], Klebsiella [7.4%], Pseudomonas [6.4%], Bacteroides [3.4%] were the organisms most commonly isolated. Bacterial isolates were single in 68.3%, multiple 7.5% and absent 24.2%. The type of organism did not correlate with severity of disease or eventual requirement for closed thoracotomy drainage, open thoracotomy drainage [Modified Eloesser*s procedure], thoracoplasty, decortication or pleuropneumonectomy. Successful methods of treatment included aspiration in 44%, tube thoracotomy in 66%, open thoracotomy drainage in 98.7%, thoracoplasty in 98%, decortication in 96% and pleuropneumonectomy in 73%. Initial mode of management in empyema thoracis are thoracentesis and closed thoracotomy drainage. If the initial management was failed, we performed another surgical procedures. Before 1973, we manage with Schede`s thoracoplasty in the postpneumonectomy empyema patients. But thoracoplasty, with or without the use of muscle flaps, is a hazardous operation in the poor-risk patients. The permanent, open thoracotomy drainage is a relatively minor operation which is well tolerated even by cachexic, septic patients. It controls infection, and sometimes results in the bronchopleural fistula closing spontaneously.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.624-629
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• 1987

Tuberculosis is one of the most common chronic disease. While the disease process may involve anywhere of the body, tuberculosis of anterior mediastinum which forming tumor like mass was not recognized commonly. We experienced a surgical case of tuberculous empyema thoracis at anterior mediastinum in 16 year old boy. Preoperatively, he was diagnosed to anterior mediastinal tumor such as teratoma or dermoid cyst by routine study. Operation was performed by midline sternotomy extending over right 4th intercostal space. The mass was elongated football shaped [20x16x15] and markedly adhered to right side of pericardium, upper 8< lower lobe of the right lung. Opening the mass, enormous pus-like material was evacuated and excised segmentally with decortication. Postoperative pathologic diagnosis was tuberculous empyema thoracis and granuloma.

• Journal of Chest Surgery
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• v.4 no.2
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• pp.95-100
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• 1971

The incidence of empyema has been drastically reduced with the advent of antimicrobial drugs,however,there is still complicated and difficult problems of management of empyema remaining. During the period of December, 1958 to December, 1962, 90 patients nf empyema thoracis were managed in the Department of Thoracic Surgery of the National Medical Center, and this series deals with the incidence,etiologic consideration, bacteriology and management of empyema with its result. 1] Male predominates with the ratio of 3.1: 1, and peak age incidence lies in 3rd decade. 2] Most common etiologic factor is bronchorespiratory infection among which tuberculosis remains highest incidence. 3] 56.7% of patients shows positive result of bacteriologic study and about half of positive culture series shows mixed infection or changing pattern of bacteriological strains during serial examinations. 4] Complete cure is obtained in 84.4% of patients with 5 deaths.