• Asif Nadeem
  • Aamir Bilal
  • S Shahkar A Shah


Background: Empyema thoracis remains a common thoracic problem with challenging management strategies. We undertook the present study to outline key aspects of the presentation and management of this condition at our tertiary care hospital. Methods: We analyzed 105 consecutive patients treated for empyema thoracis over a one-year period at Thoracic Surgical unit, Lady Reading Hospital Peshawar Pakistan. The study included patients aged 10–60 years of either sex. Patients were subjected to detailed diagnostic and management protocols with a view to define successful diagnostic and management strategies. Results: The majority of patients (68%) were male, with a mean age of 28.5±14.2 years, a majority (42%) being in the 10–20 years age group. Common presentation was with fever (73%), cough (65%) and chest pain (60%). The mean duration of symptoms was 6.1 weeks. Common aetiologies of empyema were pneumonia (46.7%), iatrogenic (21.9%), traumatic (16.2%) and malignancies (11.4%). Forty patients (38%) underwent an unsuccessful therapeutic procedure prior to admission to the Thoracic unit. In the unit, 58 patients received closed intercostal drainage (31 of which required further intervention), five patients were treated with repeated thoracentesis and 8 patients were subjected to fibrinolytic therapy. The majority of patients underwent a surgical procedure like rib resection (7), decortication (23), thoracoplasty (3) and other procedures in the first instance with only 4 patients requiring further surgery. Majority of patients (97/105, 92.4%) were cured of their disease. The hospital mortality was 7.6%. Conclusion: Multiple therapeutic options exist for the treatment of thoracic empyema. Optimal therapy requires selection of the most appropriate first procedure for each patient with post procedure imaging to avoid inordinate delays between interventions. Early referral of all empyema patients to thoracic units for definitive therapy is recommended.Key Words: Empyema, Chest Tube, Fibrinolysis, Decortication, Pneumonia. 


Adams F. The genuine works of Hippocrates. Baltimore: William and Wilkins Company;,1939;51-2.

vanSonnenberg E, Nakamoto SK, Mueller PR Casola G, Neff CC, Friedman PJ, Ferruci JT Jr., Simeone JF. CT and ultrasound guided catheter drainage of empyemas after chest tube failure. Radiology 1984;151(2):349-53.

Lee KS, Im JG, Kim YH, Hwang SH, Bae WK, Lee BH. Treatment of thoracic multiloculated empyema with intra cavitary urokinase: a prospective study. Radiology 1991;179(3):771-75.

Young WG, Ungerleider RM. Surgical approach to a chronic empyema. In: Deslaurier J, Lacquet LK, eds. Thoracic Surgery: Surgical management of pleural disease. St. Louis: CV Mosby, 1990; 247-56.

Strange C, Sahn SA. The clinician’s perspective on para-pneumonic effusions and empyema. Chest 1993;103:256-61.

LeMense GP, Strange C, Sahn SA. Empyema thoracis– therapeutic management and outcome. Chest 1995;107:1532-7.

Temes RT, Follis F, Kessler RM, Pett SB, Wemly JA. Intra pleural fibrinolytics in the management of empyema thoracis. Chest 1996;110(1):102-6.

MacKinlay ATA, Lyons GA, Chimondeguy DJ, Piedras MA, Angaramo G, Emery J. VATS debridement versus thoracotomy in the treatment of loculated postpneumonic empyema. Ann Thorac Surg 1996;61:1626-30.

Galea JL, DeSouza A, Biggs D, Spyt T. The surgical management of empyema thoracis. J R Coll Surg Edinb 1997;42:15-18.

Ashbaugh DG. Empyema thoracis: factors influencing morbidity and mortality. Chest 1991;99:1162-65.

Pothula V, Krellenstein DJ. Early aggressive surgical management of parapneumonic empyema. Chest 1994;105:832-6.