Pleurectomy case in parapneumonicpleural empyema without opening the cavity

Abstract

Pleural empyema orpyothorax is an accumulation of infected fluid or purulencein the pleural cavity. Etiological factors of thedisease genesis are pneumonia, tuberculosis, trauma consequences and intraabdominalprocesses. The most common cause of this disease is pneumonia complicated by parapneumonic effusion. Pleural empyema has 3 stages of development, which gave the basis for classification of this pathology. The first phase is exudative pleuritis associated withaccumulation of purulent exudate in the pleural cavity. For the treatment of this phase it is usually enough to realize antimicrobial therapyand drainage of the pleural cavity. The next phase of the process is fibrinous-purulent, which characterized by the encystation of fluid in the pleural cavity with the formation of multiple cavities due to the accumulation of fibrinous inclusions.At this stage of empyema development optimal treatment is to use video-assisted thoracoscopy of the pleural cavity, which allows fixing the drainage tubes under the visual control. Finally, the last phase is fibrous, which characterized by the formation of the fibrous capsule at the visceral and parietal pleuras. At this stage it is necessary to use a thoracotomy with making decortications and pleurectomy. In May 2015 there was performed pleurectomy without opening the cavity for 1 patient with parapneumonic pleural empyema in the Department of Thoracic Surgery of Voronezh Regional Clinical Hospital No 1.