title: Computed tomography or ultrasonically guided pigtail catheter drainage in multiloculated pleural empyema: a recommended procedure?
abstract: OBJECTIVE
  The role of image-guided pigtail catheter drainage in the treatment of pleural empyema is associated with different outcomes, dependent on the stage of the disease. No agreement concerning its use exists.
  
  
  METHODS
  Fourteen patients at a fibropurulent stage of pleural empyema initially treated with computed tomography (CT) or ultrasonically guided pigtail catheter drainage were reviewed. All patients were admitted with clinical symptoms of sepsis. Chest X-ray, CT scan and/or ultrasonography and thoracentesis with biochemical examination revealed multiloculated pleural empyema. Despite the diagnosis of multiloculated empyema, CT or ultrasonically guided pigtail catheter drainage was performed. However, septic symptoms deteriorated and all cases proceeded to thoracotomy with decortication.
  
  
  RESULTS
  Image-guided drainage failed in all patients. Septic symptoms disappeared within 24-48 h after decortication. The patients recovered without sequela, were discharged 6-15 days (mean: 9.2 days) postoperatively and were able to return to normal physical activity.
  
  
  CONCLUSIONS
  Computed tomography or ultrasonically guided pigtail catheter drainage can not be recommended in the case of a fibropurulent stage of empyema thoracis.
authors.affiliation: Department of Surgery, University Medical School, Karl-Franzens University, Graz, Austria. alfred.maier@klinikum-graz.at
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.forename: W
authors.initials: W
authors.lastname: Domej
authors.forename: U
authors.initials: U
authors.lastname: Anegg
authors.forename: M
authors.initials: M
authors.lastname: Woltsche
authors.forename: B
authors.initials: B
authors.lastname: Fell
authors.forename: H
authors.initials: H
authors.lastname: Pinter
authors.forename: F M
authors.initials: FM
authors.lastname: Smolle-Jüttner
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002404:Catheterization / Q000379:methods; D003663:Decision Trees; D004322:Drainage / Q000379:methods*; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014463:Ultrasonography