1/30. Management of empyema complicating lobectomy with superior vena cava replacement.We present the case of a 49-year-old man with right upper lobe adenocarcinoma invading the right brachiocephalic vein and the origin of the superior vena cava. En bloc resection of right upper lobe with the involved venous segments was carried out through a median sternotomy. Venous pathway was reestablished with a Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ) prosthesis. Postoperative course was marked by right pneumonia complicated by empyema. The patient underwent thoracotomy with completion pneumonectomy and latissimus dorsi transposition to cover both the prosthesis and the bronchial stump, as well as to fill the cavity. A favorable outcome was observed and long-term survival achieved.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/30. Refractory empyema caused by an intraoperative rib fracture sustained during esophagectomy: report of a case.A 57-year-old woman underwent esophagectomy with three-field lymphadenectomy for lower esophageal cancer, followed by gastric roll reconstruction through the posterior mediastinum. A laparotomy and right thoracotomy with partial resection of the right fifth rib were performed. A purulent discharge requiring drainage developed postoperatively and continued for 3 months despite anastomotic integrity and the absence of a bronchopleural fistula. An empyema developed 3 months after drain removal, and a thoracostomy tube was reinserted. A displaced fragment of the right fifth rib was identified within the abscess cavity. drainage and irrigation were not curative, and removal of the bone fragment was performed 18 months after the initial procedure. The patient has been symptom-free during 1 year of follow-up. We believe that the rib fragment functioned as a foreign body, which complicated treatment of the patient's postoperative infection.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
3/30. Carcinoma arising in the pleural cavity following pneumonectomy for hydatid disease.We report a case of carcinoma following 42 years of chronic empyema in a patient who underwent surgery for a hydatid cyst at the age of 3. At the time of diagnosis, an esophageal fistula was observed and treated with cyanoacrylate. We hypothesize that chronic inflammation of the pleura, caused by decades of empyema, associated with the presence of heterotopic squamous epithelium due to a long-standing esophago-pleural fistula, led to neoplastic transformation.- - - - - - - - - - ranking = 4keywords = cavity (Clic here for more details about this article) |
4/30. Closure of a large bronchial fistula with a latissimus dorsi myocutaneous flap.We describe a case of a large bronchial fistula and empyema after right upper lobectomy that was treated successfully with open window thoracostomy followed by a latissimus dorsi myocutaneous flap and limited thoracoplasty. A latissimus dorsi myocutaneous flap can provide immediate airtight closure of a large bronchial fistula, allowing lavage and curettage of the empyema cavity to reduce the chance of postoperative infection. An important aspect of this technique is that the deepithelialized skin side rather than muscle is sutured to an opening of the bronchus. As compared with other techniques, a latissimus dorsi myocutaneous flap is superior in that it requires a single incision and does not require an intraoperative change of position. In addition, the technique causes little dysfunction of the chest and shoulder and preserves the vascular supply to ensure the viability of the flap even if it was divided in a previous operation.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/30. Video-assisted thoracoscopic surgery under local anesthesia for right empyema secondary to aspiration pneumonia caused by esophageal achalasia: case report.A 55-year-old man was admitted to the Department of internal medicine of our hospital with chief complaints of fever, cough, and right-sided chest pain. Plain radiography of the chest revealed widening of the mediastinum (attributed to esophageal achalasia), pneumonia, and right pleural effusion. According to the properties of the pleural fluid, empyema was diagnosed. Because the empyema was resistant to antibiotic treatment and was in the fibrinopurulent stage, it could not be drained effectively. Therefore, after treatment of the esophageal achalasia by balloon dilatation of the lower esophagus, the empyema was treated by video-assisted thoracoscopic surgery, i.e., by video-assisted thoracoscopic drainage and curettage of the empyema cavity, under local anesthesia.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/30. Management of empyema cavity with the vacuum-assisted closure device.Management of empyema after pulmonary resection remains a challenging problem. Along with mandatory drainage of the thoracic cavity and investigations to rule out bronchopleural fistula, a reliable method of thoracic cavity closure is needed. The open thoracic window and Eloesser flap techniques rarely represent definitive therapy. Muscle flap and thoracoplasty procedures may provide well-vascularized tissue to close bronchopleural fistula and obliterate the empyema cavity, but they are quite complex and involve significant patient morbidity. We report a case of empyema without bronchopleural fistula after lobectomy in which the vacuum-assisted closure device was used to achieve complete wound healing after open drainage.- - - - - - - - - - ranking = 7keywords = cavity (Clic here for more details about this article) |
7/30. Necrotizing pneumonia and empyema due to clostridium perfringens. Report of a case and review of the literature.Clostridia are rare causes of pleuropulmonary infections in the absence of penetrating chest injuries; only 10 previous cases have been reported from civilian practice. An additional case of a rapidly progressive, necrotizing pneumonia and empyema is reported. Clostridial pneumonia is more likely to occur in patients with underlying pleuropulmonary disease. Unlike clostridial myonecrosis, it is rarely associated with toxemia; its mortality rate is comparable to that of nonclostridial pleuropulmonary infections. Appropriate antimicrobial therapy with surgical drainage of the empyema is the treatment of choice. Among the cases reviewed, an iatrogenic cause of infection involving an invasive procedure into the pleural cavity could be identified in seven of 11 cases. Aspiration of oropharyngeal contents was the likely route of infection in three other cases. In the remaining case, bacteremic seeding of the pleural cavity was the most probable mode of infection.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
8/30. Microvascular free muscle flaps for chronic empyema with bronchopleural fistula when the major local muscles have been divided--one-stage operation with primary wound closure.It should be emphasized that most cases of chest empyema can be successfully treated with conventional thoracic surgery procedures. For chronic empyema with a bronchopleural fistula complicated by previous division of major local muscles following repeated thoracotomies, free muscle flaps are employed. Five such cases treated with this method resulted in successful closure of the airway fistula, as well as complete obliteration of the empyema cavity in a single operation. This method is very effective in eradicating infection and achieves prompt wound healing, decreased morbidity, and gradual improvement of pulmonary function after surgery. Analysis of roentgen ray and computed tomographic scans before and after surgery shows lung expansion when the transferred muscles atrophy. The results are satisfactory. The method described here is not the only solution to this problem, but it is a new approach that has advantages not seen in conventional methods. It is indicated only in patients who have been operated on many times and who have no remaining available local muscles.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/30. Closure of a post-pneumonectomy bronchopleural fistula with fibrin sealant (Tisseel).A persistent post-pneumonectomy bronchopleural fistula and empyema were successfully treated by draining and cleansing the empyema cavity and then occluding the fistula with fibrin sealant.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
10/30. empyema necessitatis.empyema necessitatis is the accumulation of pus in a small space in the pleural cavity, with subsequent rupture of the purulent material into the surrounding soft tissue. drainage may occur into the breast, bronchus, mediastinum, esophagus, diaphragm, pericardium or retroperitoneum. Pus may even reach the flank, groin or thigh. Before antibiotics became available, empyema necessitatis was a complication of tuberculosis, fungal infections and various forms of pneumonia. Silent infections due to tuberculosis or fungus can still present as empyema necessitatis, even in healthy young adults.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
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