RESUMO
Late presentation and late referral of empyema thoracis poses a common and difficult problem in medical practice. It reflects the lack of awareness of some of the practitioners as regards the pathogenesis of the disease and available diagnostic tools and therapeutic options. The aim of this study is to outline clinical presentation, thoracentesis, radiological findings and treatment outcome of patients with empyema thoracis. From April 1996 to April 1998 the records of 34 patients at Al-Noor Specialist Hospital, Makkah, Saudi Arabia with the confirmed diagnosis of empyema thoracis who required thoracotomy and decortication were retrospectively reviewed. There were 28 males and 6 females; Ages ranged between 8 months to 80 years [mean [SD] 29.13 [20.16] years]. Fifty percent were Saudi nationals. Organisms were recovered only in 20% of cases. Thoracentesis with biochemical study was performed in only 58% of the cases. Tube thoracostomy concurrent with several trials [2-5 types] of broad spectrum antibiotics were the initial methods of treatment in all except 4 cases. Only 5 patients had received antibiotics against anaerobic bacteria. Thirty three thoracotomies were performed in 32 patients one of them underwent bilateral staged thoracotomy. Two patients refused surgery. Thickened pleural peel was decorticated in all patients although it was seen in only 22 CT scans of the chest. There was no mortality but morbidity occurred in 9 patients [28%]. The main complications were wound infection, prolonged air leak and residual cavity. Analysis of our patient's series-emphasizes the importance of thoracentesis in pleural effusion, early aggressive management by tube drainage and proper antibiotics against both aerobic and anaerobic organisms. These measures prevent progression of pleural infection into the late stage thus reducing the need for open thoracotomy