[The role of CT examination in the diagnosis and therapy of chronic thoracic empyema].
Successful surgical treatment of chronic intrathoracic suppuration can, in the substantial majority of cases, be accomplished only by means of major surgery or a series of thoracic operations. If a solution to the chronic process cannot be provided by decortication of the lung, or should decortication not be possible due to the moribund condition of the patient, successful treatment can still be achieved through thoracic fenestration. 314 patients were treated for chronic suppuration in the thoracic cavity between 1st January 1987 and 31st December 1997. Of these, ten died, this representing a mortality rate of 3.1%. Seven of these ten patients suffered chronic suppuration. The total number of patients suffering chronic suppuration was 73 (23.2%). Of these 73 patients, in 31 cases treatment involving two or more surgical intervention procedures was performed. Three of the ten patients on whom open surgery was performed died, these having been referred to the department already in a moribund condition. It was decided that prolonged open surgery should be performed on three patients. CT examination enables the position of the empyema, the depth of the callus surrounding it, the position of drains and the relation between the visceral pleura and the pulmonary parenchyma and their demarcation to be determined prior to open surgery with greater precision than by any other diagnostic technique developed previously. CT examination has acquired a fundamental role, subsequent to partial resection or pneumonectomy, in the examination of the bronchial trunk and in the detection of fistulae. Following open surgery CT is also appropriate for the evaluation of the dimensions of the cavity, its form, the depth of granulation tissue, retraction of the bony thoracic structure and the condition of the bronchial stump. Where there is a precedent of tumours it can provide assistance in the detection of recurrence, lymph node conditions or metastasis. Complications arising subsequent to surgery (bronchial fistula, recurrent empyema, etc.) can thus be detected in due time. Prior to thoracoplasty or myoplasty the condition of the myocutaneous lobe twisted on a neurovascular spindle and sealing the cavity can be examined clearly by means of CT, as can the viability of the transposed skin and the muscle fascicle subsequently.
Balogh
G
G
II. sz. Sebészeti- Mellkassebészeti Osztály, Kaposi Mór Megyei Kórház, Kaposvár.
Mendly
J
J
Horváth
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D013905:Thoracoplasty; D014057:Tomography, X-Ray Computed