Management of adult postpneumonic thoracic empyema

The records of 55 adult males treated for postpneumonic empyema in a recent 10-year period were reviewed. All patients underwent initial treatment by closed-tube thoracostomy. Sixteen (29%) of the patients subsequently underwent surgery because of the persistence of a large empyema cavity. Surgical procedures consisted of open-tube thoracostomy (n = 12), modified Eloesser procedure (n = 2), and decortication (n = 2). Thirty-nine patients (71%) required no operative procedure to heal empyemas. Twenty patients (36%) required multiple tube placement. Complications in patients eventually treated with operative procedures involved a single death postoperatively because of an exacerbation of congestive heart failure.