title: Large thoracomyoplasty and negative pressure therapy for late postpneumonectomy empyema with a retrosternal abscess: a modern version of the Clagett procedure.
abstract: A 63-year-old male with a history of cancer, and who had undergone a left pneumonectomy seven years before, presented with deterioration in his general status and recent dyspnea [stage III (New York Heart Association) NYHA]. Imaging revealed a contralateral mediastinal shift and cardiac compression caused by pneumonectomy cavity enlargement and a retrosternal liquid mass. Late empyema associated with a retrosternal abscess caused by Propionibacterium acnes was diagnosed after thoracoscopy and an anterior mediastinotomy. Surgical treatment included an axillary open-window thoracostomy associated with negative pressure therapy (NPT), followed by a large thoracomyoplasty where part of the latissimus dorsi was harvested, and then guided healing. The chest was closed after eight months. This case is an unusual observation of a late post-pneumonectomy empyema with Propionibacterium acnes presenting like recurring cancer, but that was treated effectively using traditional (Clagett procedure) and newer (NPT) strategies.
authors.affiliation: Department of Thoracic Surgery, University Hospital Nancy, Nancy, France. durandm@me.com
authors.forename: Marion
authors.initials: M
authors.lastname: Durand
authors.forename: Benoit
authors.initials: B
authors.lastname: Godbert
authors.forename: Valentine
authors.initials: V
authors.lastname: Anne
authors.forename: Gilles
authors.initials: G
authors.lastname: Grosdidier
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D004322:Drainage; D016724:Empyema, Pleural / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011013:Pneumonectomy / Q000009:adverse effects*; D011425:Propionibacterium acnes / Q000302:isolation & purification; D013524:Surgical Flaps; D020775:Thoracic Surgery, Video-Assisted; D013907:Thoracostomy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents