The Journal of Thoracic and Cardiovascular Surgery, Vol 82, 58-62, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Results of decortication in chronic empyema with special reference of paragonimiasis
RB Dietrick, RM Sade and JS Pak
During a recent 6 years period, we managed chronic empyema by
decortication, either alone or in combination with thoracoplasty, in 58
patients: In 16 patients, the empyema was a complication of Paragonimus
westermani infestation (PWI), in 20, tuberculosis (TB), and in 22, of
varied origins. There were no operative deaths, and satisfactory or good
results were obtained in 55 patients (94.8%). We believe that the result in
a patient in whom thoracoplasty is required should be called satisfactory,
not good. Only 55% of the TB group achieved a good result, compared with
89% of the other patients. Of the 10 patients who required a thoracoplasty,
seven were in the TB group. Empyema complicating TB is associated with a
higher incidence of fistula formation and is more difficult to treat than
other empyemas. The empyema associated with PWI develops more slowly, tends
to form fewer fistulas, and eventuates in a good result more often than
empyema associated with TB. Two of our three poor results stemmed from
failure to do a thoracoplasty when the lung did not expand. We recommend
thoracoplasty when the lung does not expand well at operation; it should be
done at the time of decortication to avoid the necessity for a second major
procedure. Chronic empyema is a common complication of paragonimiasis in
Korea and by inference in other parts of the world where PWI is endemic. As
international travel increases, some patients with PWI and complicating
empyema may be seen in the United States. American thoracic surgeons should
be aware of this disease, its treatment and its chest complications.
