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Ann Thorac Surg 1996;61:1630
© 1996 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Joseph I. Miller, Jr, MD

Department of Cardiothoracic Surgery, The Emory Clinic, 25 Prescott St, NE, Suite 3420, Atlanta, GA 30308

See also page 1626.

This article illustrates several important points. First, the key is to intervene early in the fibrinopurulent stage (stage II of Light) before organization sets in. Our approach would be to obtain a computed tomographic scan when loculation is suspected and at the same time insert a computed tomography--directed catheter into the space. If the loculation did not resolve and the lung expanded within 48 hours (with or without mucolytics) then thoracoscopy would be the approach. Once organization sets in and a peel begins to form, then an open approach is required. The algorithm given by Angelillo Mackinlay and associates is an excellent stepwise approach to this problem. Almost all loculated pediatric pleural empyemas can be treated thoracoscopically. Our pediatric surgeons now intervene within the first week when initial drainage with a chest tube is unsuccessful. Approximately 30 cases have been treated as such within the past 2 years with no significant morbidity or mortality.

This is an excellent article, and its authors are to be congratulated.


Related Article

VATS Debridement Versus Thoracotomy in the Treatment of Loculated Postpneumonia Empyema
Tomás A. Angelillo Mackinlay, Gustavo A. Lyons, Domingo J. Chimondeguy, Miguel A. Barboza Piedras, Gustavo Angaramo, and Juan Emery
Ann. Thorac. Surg. 1996 61: 1626-1630. [Abstract] [Full Text]




This Article
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