A novel approach to life-threatening cardiorespiratory distress from mediastinum exclusion type chronic empyema.
OBJECTIVE
Mediastinal exclusion type of empyema (MEE) is known as a type of chronic matrical empyema with no retention of pus. However, the number of patients with this condition who undergo treatment is still very limited because the indications for a panpleuropneumonectomy, namely the main surgical treatment for MEE, are extremely rare due to their unfavorable conditions. As a result, most cases of this disease are left untreated.


METHODS
From April 2000 to December 2002, we experienced four cases of MEE, in which the conditions were so aggravated that cardiorespiratory insufficiencies were involved with them. All of them had been receiving oxygen therapy at home and the severity of symptoms were rated as III or IV according to the Hugh-Jones classification. The patients required surgical treatment as a semiemergency.


RESULTS
We successfully performed safe and effective treatment in all cases through a novel approach with a devised incision and the severance of the osseous thorax for a panpleuropneumonectomy.


CONCLUSIONS
We hope our newly devised operative method discussed herein will improve the outcome and postoperative management of chronic MEE patients.
Division of the General Thoracic Surgery, Takarazuka Municipal Hospital, Hyogo, Japan.
Norihisa
N
Shigemura
Akinori
A
Akashi
Tomoyuki
T
Nakagiri
D000368:Aged; D002908:Chronic Disease; D016724:Empyema, Pleural / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D009752:Nutritional Status; D011013:Pneumonectomy / Q000379:methods*; D011184:Postoperative Period; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies