The Management of Tuberculous Empyema

¹ VA Hospital, Oteen, North Carolina., Manager, VA Hospital, Baltimore, Maryland.

In 1931 a Committee Report on the Treatment of Tuberculous Empyema was submitted by Leroy S. Peters, Paul Ringer, J. J. Singer, and E. S. Welles. Among other conclusions were these:

1. Most tuberculous empyemata are best treated by no treatment.

2. Aspiration is justified to relieve high fever and pressure symptoms.

3. Closed or open drainage is not warranted since it converts a simple empyema into a pyogenic one.

In the years following that report and before the advent of successful chemotherapy, considerable reduction in mortality had been brought about by the more frequent use of thoracoplasty with or without preliminary drainage.

The demonstration of the bacteriostatic effect of streptomycin in 1946 opened the door for further improvements in the management of tuberculous empyema.

Active treatment has replaced inactivity. As soon as a diagnosis is established a carefully formulated program is set in motion with the objectives of elimination of toxicity, stabilization of the disease process and obliteration of the empyema space. These goals may occasionally be accomplished with chemotherapy and thoracentesis. Most commonly, however, chemotherapy accompanied by drainage, decortication, thoracoplasty, or resection is required.