title: Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy.
abstract: BACKGROUND
  In cases of empyema, some form of intervention, either chest tube drainage, thoracoscopy, video-assisted thoracic surgery (VATS), or thoracotomy, with or without pleural fibrinolysis, is required. What the best approach is and when and how to intervene is a matter of debate.
  
  
  OBJECTIVE
  To analyze the safety and outcome of medical thoracoscopy in the treatment of multiloculated empyema.
  
  
  METHODS
  We report a retrospective series of 127 patients with thoracic empyema treated with medical thoracoscopy from 1989 to 2003 in three hospitals in Switzerland and Italy. All patients had multiloculated empyema as identified by chest ultrasonography. In the absence of multiloculation, or in case of fibrothorax, simple chest tube drainage or surgical VATS/thoracotomy were performed, respectively.
  
  
  RESULTS
  Mean age +/- SD was 58 +/- 18 years (range, 9 to 93 years). In 47%, a microbiological diagnosis was made. Complications occurred in 9% of patients (subcutaneous emphysema, n = 3; air leak of 3 to 7 days, n = 9). No mortality was observed. Forty-nine percent of patients received postinterventional intrapleural fibrinolysis. Medical thoracoscopy was primarily successful in 91% of cases. In four patients, the insertion of an additional chest tube or a second medical thoracoscopy was required. Finally, 94% of patients were cured by nonsurgical means. Six percent of patients required surgical pleurectomy, mostly through thoracotomy.
  
  
  CONCLUSIONS
  Multiloculated empyema as stratified by ultrasonography can safely and successfully be treated by medical thoracoscopy.
authors.affiliation: Department of Pneumology, University Hospital Basel, Switzerland. mbrutsche@uhbs.ch
authors.forename: Martin H
authors.initials: MH
authors.lastname: Brutsche
authors.forename: Gian-Franco
authors.initials: GF
authors.lastname: Tassi
authors.forename: Sandor
authors.initials: S
authors.lastname: Györik
authors.forename: Marlon
authors.initials: M
authors.lastname: Gökcimen
authors.forename: Christophe
authors.initials: C
authors.lastname: Renard
authors.forename: Gian Pietro
authors.initials: GP
authors.lastname: Marchetti
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Tschopp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015505:Chest Tubes; D004322:Drainage; D016724:Empyema, Pleural / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy; D016896:Treatment Outcome; D014463:Ultrasonography