title: Is medical thoracoscopy efficient in the management of multiloculated and organized thoracic empyema?.
abstract: BACKGROUND
  Pleural empyema can be subdivided into 3 stages: exudative, multiloculated, and organizing. In the absence of clear septation, antibiotics plus simple drainage of pleural fluid is often sufficient treatment, whereas clear septation often requires more invasive treatment.
  
  
  OBJECTIVE
  The aim of this study was to report our experience and analyze the safety and efficacy of medical thoracoscopy in patients with multiloculated and organizing empyema.
  
  
  METHODS
  We performed a retrospective study reviewing the files of patients referred for empyema and treated by medical thoracoscopy at our department from July 2005 to February 2011.
  
  
  RESULTS
  A total of 41 patients with empyema were treated by medical thoracoscopy; empyema was free flowing in 9 patients (22%), multiloculated in 24 patients (58.5%), and organized in 8 patients (19.5%). Medical thoracoscopy was considered successful without further intervention in 35 of 41 patients (85.4%): all of the 9 patients with free-flowing fluid, 22 of the 24 patients with multiloculated empyema (91.7%), and only 4 of the 8 patients with organizing effusion (50%).
  
  
  CONCLUSIONS
  Our study confirms that multiloculated pleural empyema could safely and successfully be treated with medical thoracoscopy while organizing empyema can be resistant to drainage with medical thoracoscopy, requiring video-assisted thoracic surgery or open surgical decortications; among this population, the presence of separate 'pockets' not in apparent communication with each other often leads to a surgical approach.
authors: Department of Disease of the Thorax, Pulmonology Unit, Morgagni Hospital, Forlì, Italy.
authors: Claudia
authors: C
authors: Ravaglia
authors: Carlo
authors: C
authors: Gurioli
authors: Sara
authors: S
authors: Tomassetti
authors: Gian Luca
authors: GL
authors: Casoni
authors: Micaela
authors: M
authors: Romagnoli
authors: Christian
authors: C
authors: Gurioli
authors: Vanni
authors: V
authors: Agnoletti
authors: Venerino
authors: V
authors: Poletti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004322:Drainage / Q000379:methods*; D016724:Empyema, Pleural / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult