title: Open drainage of massive tuberculous empyema with progressive reexpansion of the lung: an old concept revisited.
abstract: BACKGROUND
  This study examined the results of open drainage of massive tuberculous empyema.
  
  
  METHODS
  During a 7-year period 47 patients with primary mixed chronic tuberculous empyema with near or total lung collapse were treated. The initial procedure was chest tube suction drainage, which permitted evaluation of the pleural cavity and the lung parenchyma despite minimal if any reexpansion of the lung. All patients were treated with antibiotics and multidrug regimens of antituberculosis agents. A pleurocutaneous window was established by removing sections of two ribs one intercostal space above the base of the pleural cavity. Irrigation was performed daily with dilute povidone iodine solution.
  
  
  RESULTS
  Twenty-eight patients achieved complete reexpansion of the lung after 4 to 30 months of drainage and are cured. Eleven are in various stages of reexpansion and probably will be cured. Eight patients did not achieve reexpansion. Criteria were established retrospectively on an ongoing basis that indicate when pulmonary reexpansion is possible.
  
  
  CONCLUSIONS
  These totally collapsed "entrapped" lungs expanded to fill the entire pleural space despite the presence of bronchopleural fistulas and an "open" pleura. Reexpansion was progressive, gradual, and dependent on improved compliance, clearing of bronchial inflammation and obstruction, and pleural cleansing. Criteria are established that identify those patients in whom complete reexpansion may take place and the disease may be cured.
authors.affiliation: Department of Surgery, Aga Khan University, Karachi, Pakistan.
authors.forename: S M
authors.initials: SM
authors.lastname: Ali
authors.forename: A A
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: J S
authors.initials: JS
authors.lastname: McLaughlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015505:Chest Tubes; D002648:Child; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D004654:Empyema, Tuberculous / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011859:Radiography
chemical_list: D000995:Antitubercular Agents