Chronic Pleural Empyema

(Its Surgical Treatment)

A study of the reported cases of chronic post pneumonic empyema reveals that the single most important cause of this condition is error in the management of acute empyema. Inadequate drainage is the single most important factor in the causation of chronicity of this lesion. Tuberculosis and a variety of miscellaneous causes account for the remaining cases.

A method of surgical obliteration of chronic empyema cavities has been presented. The advantages of this method are: (1) The preservation of the intercostal nerves and vessels, with the absence of paresthesia and herniation of the abdominal wall. (2) The preservation of the periosteum of the resected ribs, resulting in regeneration of bone and stabilization of the chest wall. (3) The intercostal bundles, when stripped of the underlying thickened parietal pleura, have an abundant blood supply and adhere very quickly to the visceral pleura, thus producing rapid obliteration of the chronic empyema cavity. The rapid healing of the wound following this procedure is a decided advantage.

The procedure has been used in 13 chronic empyemas due to pyogenic organisms and 4 chronic tuberculous empyemas with encouraging results.