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Abstract : |
We report a 48 years old patient who developed a residual cavity with empyema after a decortication performed in another unit 1,5 years ago, which had been treated with repeated thoracenthesis, tube thoracostomies and antibiotic treatments. All the bacteriologic probes were negative for tuberculosis but pathologic examination of pleural deposits removed during decortication was not performed. We performed an one-stage thoracopleuroplasty on 7 ribs, Botianu personal procedure. Postoperative course was initially favourable, followed by development of a residual cavity with a volume reduced to half of the initial one, which was treated by a modified Eloesser open-window procedure. Pathologic examination of pleural deposits showed specific inflammation which explains the unfavourable evolution in the absence of a tuberculostatic treatment. Healing was achieved by daily dressings and full antituberculous treatment. Pathologic examination of pleural deposits removed during surgery is mandatory since it may diagnose specific inflammation and change the treatment and outcome. Absence of a correct etiologic diagnosis and treatment explains failure of multiple procedures requiring an open-window for the local control of infection., |
