Chronic Empyema
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2021 ◽  
Author(s):  
Lei Wang ◽  
Zhongliang He

Abstract BackgroundChronic empyema with chest wall sinus is a complex and refractory disease caused by multiple factors.It may be combined with bronchopleural fistula, residual bone and other necrotic tissue,causing local infection difficult to control, and the disease is a vicious circle.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 11 years ago and began to develop empyema with purulent sinus in the anterior chest wall 3 years ago. Therefore, he was admitted to our medical center for further treatment. Chest computed tomography (CT) showed the right pleural effusion with the chest wall rupture sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the large empyema cavity,the patient should be treated with free vastus lateralis musculocutaneous flap combined with pedicled pectoralis major muscle flap transplantation.After the operation, acute respiratory failure occurred due to left lung aspiration pneumonia.ConclusionsAfter a series of treatment measures such as tracheal intubation, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, he was finally rescued and cured.Follow-up after discharge showed that the tissue flap survived and empyema was eliminated.


2021 ◽  
Author(s):  
Lei Wang ◽  
Zhongliang He

Abstract BackgroundChronic empyema with chest wall sinus is a complex and refractory disease caused by multiple factors.It may be combined with bronchopleural fistula, residual bone and other necrotic tissue,causing local infection difficult to control, and the disease is a vicious circle.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 11 years ago and began to develop empyema with purulent sinus in the anterior chest wall 3 years ago. Therefore, he was admitted to our medical center for further treatment. Chest computed tomography (CT) showed the right pleural effusion with the chest wall rupture sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the large empyema cavity,the patient should be treated with free vastus lateralis musculocutaneous flap combined with pedicled pectoralis major muscle flap transplantation.After the operation, acute respiratory failure occurred due to left lung aspiration pneumonia.ConclusionsAfter a series of treatment measures such as tracheal intubation, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, he was finally rescued and cured.Follow-up after discharge showed that the tissue flap survived and empyema was eliminated.


2021 ◽  
Vol 15 (2) ◽  
pp. 106-110
Author(s):  
Lucimara Strugava ◽  
Andressa Duarte Lorga ◽  
Anny Raissa Carolini Gomes ◽  
Ana Paula Rossa ◽  
Jéssica do Rocio Janiszewski ◽  
...  

The aim of this paper is to report the Salpingopharyngeus fistula technique by means of videosurgery through a natural orifice (NOTES) in order to treat bilateral empyema. A mare was seen at the Large Animal Sector of UFPR, with a history of bilateral purulent nasal discharge associated with dysphagia lasting for ninety days. The animal was submitted to endoscopy, showing a moderate amount of purulent secretion in both guttural pouches. With no improvement on the clinical treatment, we opted for surgical treatment by endoscopy through Salpingopharyngeus fistula made with the aid of a device containing an electrical scalpel developed to perform this technique. It consisted of making an incision in the pharyngeal recess in order to access the guttural pouches and subsequently drain the purulent content. The patient was discharged at the same day and returned to work 30 days after the procedure. Surgical treatment for cases of guttural pouch empyema is indicated when the clinical resolution has not been effective, and the minimally invasive technique is indicated due to the reduction of risks and the easiness of postoperative management. Until this moment, there are no reports of the salpingopharyngeal fistula technique through video surgery for the treatment of guttural pouch empyema, which has proved to be efficient for the treatment of the disease.


2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
Klein Dantis

Early, aggressive, and minimally invasive approach is an advanced surgical approach for chronic empyema management. The traditional video-assisted technique is considered superior over open thoracotomy for empyema management; however, with further modification, the uniportal video-assisted thoracoscopic surgery (UVATS) has greater advantage for surgeons, providing better anatomical view of target tissues, allowing bimanual instrumentation similar to open approach, and nullifying the creation of dihedral angle by instruments that are not favorable in traditional VATS. The present case series describes different clinical scenarios including chronic empyema secondary to traumatic hemothorax, recurrent tubercular empyema following postoperative open decortication, and methicillin-resistant staphylococcus aureus chronic empyema in pediatric patient, which are effectively managed with UVATS approach.


2021 ◽  
Vol 54 (3) ◽  
pp. 228-231
Author(s):  
Jeong In Hong ◽  
Hong Ju Shin ◽  
Won-Min Jo ◽  
Jae Seung Shin ◽  
Jinwook Hwang
Keyword(s):  

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yongyong Wu ◽  
Zhongliang He ◽  
Weihua Xu ◽  
Guoxing Chen ◽  
Zhijun Liu ◽  
...  

Abstract Background Bronchopleural fistula (BPF) refers to an abnormal channel between the pleural space and the bronchial tree. It is a potentially fatal postoperative complication after pulmonary resection and a complex challenge for thoracic surgeons because many patients with BPF ultimately develop refractory empyema, which is difficult to manage and has a major impact on quality of life and survival. Therefore, an operative intervention combined with conservative and endoscopic therapies may be required to control infection completely, to occlude BPF, and to obliterate the empyema cavity during treatment periods. Case presentation Two patients who suffered from BPF complicated with chronic empyema after lobectomy were treated in other hospitals for a long time and did not recover. In our department, we performed staged surgery and creatively combined an Amplatzer Septal Occluder (ASO) device (AGA Medical Corp, Golden Valley, MN, USA) with pedicled muscle flap transposition. First, open-window thoracostomy (OWT), or effective drainage, was performed according to the degree of contamination in the empyema cavity after the local infection was controlled. Second, Amplatzer device implantation and pedicled muscle flap transposition was performed at the same time, which achieved the purpose of obliterating the infection, closing the fistula, and tamponading the residual cavity. The patients recovered without complications and were discharged with short hospitalization stays. Conclusions We believe that the union of the Amplatzer device and pedicle muscle flap transposition seems to be a safe and effective treatment for BPF with chronic empyema and can shorten the length of the related hospital stay.


2021 ◽  
Vol 35 (4) ◽  
pp. 337-343
Author(s):  
Shinobu Katagiri ◽  
Hideki Endoh ◽  
Takahiro Tachibana ◽  
Nobuhiro Nishizawa ◽  
Yukitoshi Satoh ◽  
...  

2021 ◽  
Author(s):  
Lei Wang ◽  
Zhongliang He ◽  
Guoxing Chen ◽  
Shunxin Xin ◽  
Chun Zhang

Abstract Background: To explore the effects of autologous free dermal graft combined with free myocutaneous flap on bronchopleural fistula with empyema. Methods: Two patients with refractory empyema and bronchopleural fistula were treated with autologous free dermal graft combined with free myocutaneous flap. The free dermal graft was harvested from the skin around the incision and the fistula was sutured intermittently. The lateral femoral myocutaneous flap was selected as the free flap. Using microsurgery techniques, the descending branch of the lateral femoral circumflex artery and the thoracodorsal blood vessel were anastomosed intermittently to maintain the blood supply of the myocutaneous flap. After surgery, the empyema, air leakage, and the survival of the myocutaneous flap were observed. Results: No necrosis of the myocutaneous flap was observed after surgery. There was no disease recurrence after follow-up for seven and six months, respectively. Re-examination of the chest computed tomography or magnetic resonance imaging indicated that the empyema residual cavity had disappeared. Conclusion: Autologous free dermal graft combined with free lateral femoral myocutaneous flap transplantation is effective in the treatment of patients with bronchopleural fistula with refractory chronic empyema, with satisfactory clinical effects.


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