[Application of early videothoracoscopic pulmonary decortication in the treatment of an acute pleural empyema and suppurated clotted hemothorax]

There was presented the experience of performance of videothoracoscopic pulmonary decortications in 22 patients, suffering suppurated clotted hemothorax, and in 188--an acute pleural empyema. In 97.3% patients the cessation of purulent process and pulmonary volume restoration were achieved. Residual cavities with the pulmonary nonairtightness signs were revealed in 3 (1.4%) patients, the empyema recurrence--in 1 (0.5%), suppuration of the wound, made by thoracic port--in 1 (0.5%), all the patients are alive.

[Thoracic empyema due to subphrenic appendicitis: an infrequent presentation]

Acute appendicitis is the most common abdominal surgical emergency. Atypical presentations lead to a late diagnosis with a higher complication rate. Given its rarity, we report a case of a thoracic empyema due to subphrenic appendicitis.

Chest tube injury to left ventricle: complication or negligence?

An injury to the left ventricle after a chest tube insertion is a rare but lethal phenomenon that is likely to occur if precautions are not seriously addressed. We present a 15-year-old girl who was diagnosed a left empyema thoracis. An attempt to place a chest drain in this young girl was almost fatal. A left ventricular repair together with thoracotomy and decortication were successful. This case emphasizes the rarity of this lethal complication and the importance of the correct technique for chest tube insertion.

[Pyothorax due to ruptured lung abscess successfully treaed by video-assisted thoracic surgery; report of a case]

A 30-year-old female was admitted to our hospital for chest pain and dyspnea We diagnosed lung abscess of the left lung. On day 2, the patient required mechanical ventilation for pneumopyothorax due to ruptured lung abscess with acute respiratory distress syndrome. We managed this patient antibiotics, sivelestat sodium hydrate and steroid pulse therapy. Curettage and decortication for empyema cavity and closure of bronchopleural fistula was done under video-assisted thoracic surgery with minithoracotomy on day 17. Postoperative course was uneventful.

Late onset postpneumonectomy empyema presenting 24 years after pneumonectomy

Empyema is a devastating complication that is rarely seen in the postpneumonectomy setting. A 56-year-old man presented to us 24 years after pneumonectomy with a 15 days history of chest pain and shortness of breath. Physical examination revealed a fluctuant swelling at the thoracotomy site. Computed tomography scan showed a large fluid density mass in the left pneumonectomy space. Needle aspiration and video assisted thoracoscopic surgery was carried out and culture of the aspirated fluid grew Pseudomonas aeruginosa. The patient was discharged with the chest tubes in place. At 2 months follow-up, the patient presented with fever and continuous copious drainage of pus from empyema tubes. Piperacillin with tazobactam at 4.5 grams per day helped in the resolution of fever but the output from the empyema tubes continued. An open window thoracostomy was performed and the patient was discharged on standard dosage of cefixime and fusidic acid. Following this antibiotic regimen, he remained stable with complete resolution of the infection.

[Video-assisted thoracic surgery for spontaneous rupture of the esophagus]

A spontaneous rupture of the esophagus occurs rarely, and its mortality rate is relative high if it was lately diagnosed, or treated. We here report the case of spontaneous rupture of the esophagus which were successfully treated with omentopexy under the video-assisted thoracic surgery (VATS).

[Late-onset postpneumonectomy empyema]

INTRODUCTION

Empyema occurring after pneumonectomy is a major complication usually diagnosed during the same hospitalization. However, late-onset empyemas are not infrequent and may be difficult to diagnose and manage.

PATIENTS AND METHODS

From 1995 to 2008, 15 patients were referred to our department for an empyema that occurred between four months and 16years following a pneumonectomy (mean is equal to four years). We more particularly reviewed the mode of occurrence, the possible causes and the management of those late infections.

RESULTS

Presentation and characteristics were miscellaneous and delay in diagnosis was generally the rule. Two tendencies were emerging according to the delay of occurrence. During the first year following the pneumonectomy, the patients (n=8) had often received an adjuvant treatment (radiation therapy: n=2; radiation and chemotherapy: n=1; chemotherapy: n=2), often presented a bronchial fistula (n=5), and post-management morbidity (two deaths). After the first year, the patients (n=7) were without bronchial fistula, had rarely received an adjuvant therapy (n=1), and were rather suffering multiple associated diseases (n=3), or a bacteremia (n=3), and the treatments were more rapidly efficient.

CONCLUSION

Empyema is among the first diagnoses to think about in case of fever occurring late after pneumonectomy. Early diagnosis may permit more rapid management and hence, easier and better recovery.

Isolation of Candida species is an important clue for suspecting gastrointestinal tract perforation as a cause of empyema

BACKGROUND

Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood.

OBJECTIVE

To elucidate the clinical features of Candida empyema.

METHODS

We retrospectively reviewed the cases of 128 patients with culture-positive empyema.

RESULTS

These 128 patients included 7 whose cause of empyema was esophago- or gastropleural fistula. Empyema was due to Candida species in 5 of the 7 patients. Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. None of these 5 patients had esophageal candidiasis. Among the 121 other patients with empyema not due to esophago- or gastropleural fistula, no patient had empyema due to Candida.

CONCLUSION

We believe that the empyema in these 5 patients was caused by normal commensal Candida species entering the pleural cavity when the fistula between the gastrointestinal tract and pleural cavity was formed. Isolation of Candida species can be an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.

Pyothorax-associated lymphoma diagnosed by preoperative pleural effusion aspiration cytology: a case report

BACKGROUND

Pyothorax-associated lymphoma (PAL) is a comparatively rare tumor, and it is difficult to definitively diagnose it preoperatively, especially in patients with only pleural thickening without mass formation. Pleural effusion aspiration cytology is a useful and easy diagnostic method for a large number of chest diseases. However, the cytologic findings of PAL have been rarely described. Here we report on the cytologic findings in a patient with PAL, manifested by pleural thickening without mass formation, and which was diagnosed preoperatively by pleural effusion aspiration cytology.

CASE

A 64-year-old man was admitted to our hospital because of pleural thickening involving an empyema sac located in the left thorax and rapidly increasing pleural effusion. He had a 30-year history of chronic empyema and a 10-year history of diabetes mellitus. Left pleural effusion aspiration cytology showed malignant lymphoma. The patient was admitted to our hospital for PAL treatment. Because of poor respiratory function, he only underwent decortication with complete resection of the thickening pleural peel. However, he was well, without recurrence, 5 years after the operation. The histologic examination revealed that lymphoma cells were located only in the thickening pleural peel.

CONCLUSION

This is a very rare case of PAL diagnosed by preoperative aspiration cytology for an increasing pleural effusion. This report demonstrates that pleural effusion aspiration cytology can be valuable for the diagnosis of PAL.

Transsternal transpericardial closure of a postpneumonectomy bronchial fistula in a patient who underwent pneumonectomy because of a war injury

Most common causes of intrathoracic empyema include pulmonary infections and postoperative bronchopleural fistulas complicating a lung surgical resection, mainly pneumonectomy, as a result of the failure of the bronchial stump to heal. A 22-year-old Serbian patient presented with chronic posttraumatic empyema. Two years before during a war, he experienced chest injury due to a firearm wound, with massive intrathoracic bleeding and need for emergency left pneumonectomy. Empyema with a bronchopleural fistula occurred during the postoperative course. The patient underwent left open window thoracostomy with a daily bandage change. Here we report the treatment of the bronchopleural fistula using sequential surgical approach including transsternal transpericardial closure of the fistula followed by reconstruction of the chest wall with a regional muscle flap. Our case report highlights the feasibility and efficacy of the transsternal surgical approach to treat postpneumonectomy bronchopleural fistula, thereby avoiding the direct approach to the bronchial stump through the infected pneumonectomy cavity.

Pneumococcal infection and hemolytic uremic syndrome

BACKGROUND

Hemolytic uremic syndrome, one of the common causes of acute renal failure in children, is characterized by the triad of microangiopathy, haemolytic anemia, thrombocytopenia and acute renal failure. The diarrhoea-associated Hemolytic uremic syndrome is usually termed as a typical Hemolytic uremic syndrome. Streptococcus pneumoniae is an uncommon etiological pathogen for inducing Hemolytic uremic syndrome, and Streptococcus pneumoniae associated Hemolytic uremic syndrome is also termed as atypical hemolytic uremic syndrome.

AIM

to report two pediatric cases of invasive S pneumoniae complicated with hemolytic uremic syndrome HUS.

CASE REPORT

The first patient presented with pneumococcal pneumonia and empyema and the second patient presented with pneumococcal pneumonia and meningitis. The two patients were under one year of age and required peritoneal dialysis with improvement of renal function in one; the other died.

CONCLUSION

Pneumococcal invasive disease may be a cause of severe HUS, so a high index of suspicion is mandatory to prompt appropriate diagnosis and management.

[Drug treatment with fibrinolytics (corrected) of secondary empyema secondary to complicated parapneumonic effusion]

In recent years we have observed in our country an increase in complications associated with bacterial pneumonia, such as pleural effusion and empyema. The initial treatment is an association of antibiotics, covering the potential germ involved, and the placement of a pleural drainage tube, in order to accelerate the resolution process. Formation of septa within the pleural cavity requires additional therapy (antifibrinolytic treatment, videothorascopy), but no one of these two alternatives is been demonstrated better than the other. We present a review that covers last 15 years (1990-2006), related to management of empyema. The management strategy with initial instillation of antifibrinolytic intrapleural makes our series the longest in our country using such treatment (30 of 50 patients reviewed (60) were treated with this technique). Initial success was 96% with this modality, without rescuing surgery. There is also a descriptive analysis of several clinical, laboratory and radiological parameters. In comparative analysis, length of stay in intensive care unit decreases in those patients treated with antifibrinolytics. This result is a prove of the efficacy of this treatment, and quite encourageing.

[Inflammatory diseases of the thorax]

Inflammatory diseases of the thorax can affect its own lungs, pleural cavity, mediastinum or chest wall. They often complicate the treatment of traumatic injury of the thorax. Even infectious complication after intrathoracic surgery are not rare. The early removal of infectious substance (tissue, fluid) and relevant antibiotics therapy are basis of surgical treatment. This article deal about infection of the thorax in surgery and posibilities of treatment options. Contribution of well-timed surgical intervention is demonstrated on case report of patient with infectious complication after traumatic thorax injury.

Massive empyema associated with transient hypogammaglobulinemia of infancy and IgA deficiency

Transient hypogammaglobulinemia of infancy (THI) is originally defined as a physiological maturation defect of immunoglobulin G (IgG) production that occurs at 3-6 months of age and lasts until 18 to 36 months of age. We report here on a 22-month-old child with THI and IgA deficiency, who had massive pneumococcal empyema. Her depressed IgG level returned to normal within 6 months, but IgA level was still low at 6 yr of age. Although THI is an age-dependent and self-limiting disorder, severe infection that includes an atypical presentation of an infection may occur in some patients and this requires evaluation with immunologic study.

PleurX catheter for the management of refractory pleural effusions in congestive heart failure

Pleural effusions that are caused by congestive heart failure and refractory to medical management are rare, and the options for treating them are few and sometimes ineffective. We report here our experience, over a 2-year period, with a novel device, the Denver Biomedical PleurX pleural catheter, in treating a series of 5 patients who had chronic, refractory, heart-failure-associated pleural effusions. The PleurX catheter is a small-bore chest tube designed to remain in place for prolonged periods, through which drainage of pleural fluid can be performed easily on a daily or less frequent outpatient basis. Placement of the catheter, in our series, was associated with no complications. In all patients, the catheter effectively drained the pleural space initially, thereby controlling the effusions and alleviating New York Heart Association functional class IV symptoms. The catheters remained in place for a period of 1 to 15 months. In 2 of the patients, the catheter was associated with no complications during the time that it remained in place. One of these patients had the catheter removed at heart transplantation, and 1 retained the catheter until death from underlying heart disease. For 1 patient, the catheter resulted in a partially loculated pleural space, and it was removed. In 2 patients, after prolonged use, it was associated with empyema, for which it was removed. We conclude that the PleurX catheter can effectively control refractory congestive-heart-failure-associated pleural effusions temporarily, but that its prolonged use can cause significant complications, most importantly empyema.

[Results of treatment of lung cancer complicated by postoperative pleural empyema]

An evaluation of the literature and our own experience with surgical and combined treatment of lung cancer complicated by postoperative pleural empyema established the following incidence rates in 2.4% of patients: postpneumonectomy (4.2%), particularly on the side (57.4%), and in tumor stage III cases (70.6%). Bronchal stump failure (89.7%) was the main cause of postoperative pleural empyema while the risk doubled (4.5-6.0%; p < or = 0.05) after neoadjuvant therapy. Both immediate and end results were worse in postoperative pleural empyema than in similar uncomplicated cases: 12 month survival--43.8% vs. 71.1%; 3-year--18.8-36.8%; 5-year--10.4-26.3%. Also, postoperative pleural empyema patients stayed in hospital longer.

[Surgical treatment for destructive pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema]

The results of surgical treatment were analyzed in 205 patients with destructive pulmonary tuberculosis complicated by spontaneous pneumothorax and pleural empyema. The long-term course, extent, and activity of a tuberculous and purulent process in the lung and pleura determined the patients' severe condition and low respiration and cardiac function parameters. After complex preoperative preparation during 3-4 months, surgical treatment was performed in 84.9% of the patients after stabilization of a pneumopleural process and an intervention was made in 15.1% in the active phase of the disease. A good immediate efficiency was stated in 80% of the patients with this pathology, of them this was observed in 70.4% after pulmonectomy and pleuropulmonectomy, in 88.1% after pleurectomy and partial lung resection, and in 89.6 following thoracomyoplasty. The overall hospital mortality was 11.7%.