Contemporary surgical management of thoracic empyema

Abstract

In the USA, one million patients diagnosed with pneumonia are admitted each year and among these, 32,000 patients develop empyema (1,2). Empyema is associated with a high morbidity and mortality (2,3). Empyema was first described by Hippocrates 2,400 years ago. He also performed the first pleural drainage when he created a burr hole to drain the infected fluids and performed daily irrigation (4). Thoracic empyema is defined as either presence of bacterial organisms and/or presence of grossly purulent fluid in the pleural cavity. A positive culture is not required for diagnosis of patients previously on antibiotics. As well, in the case when a sampling was taken of the inflammatory fluid from around the infected empyema fluid, or in anaerobic bacterial infections which are difficult to be cultured.