Empyema Thoracis

Empyema thoracis can occur as a result of Pleural TB or parapneumonic effusion (PPE) that occurs in patients with concurrent LRTI or pneumonia. Pleural space is the second most common site of extrapulmonary TB.

During primary TB or reactivation of TB, pleural infection turns into a true empyema, characterized by an opaque, purulent effusion. Chronic empyema typically occurs 4 to 6 weeks from the development of a pleural effusion and is characterized by a rigid cortex encasing the lung, the chest wall, and the diaphragm.

The narrowing of the intercostal spaces and the secondary atelectasis produce a unilateral loss of volume of the chest culminating in a restrictive ventilatory syndrome with ventilation-perfusion mismatch and finally dyspnea.

Patients finally require surgery (Lung Decortication) for both proper evacuation of the infection and re-expansion of the "trapped lung." Thoracotomy was the mainstay of surgery until increasing experience in video-assisted thoracoscopic surgery (VATS) worldwide allowed considering thoracoscopic debridement and decortication as a valid, less invasive alternative with wider indications.