Pathophysiology
In a case of Aspergillus empyema following pneumonectomy, exposed silk suture at the bronchial stump facilitated the extension of infection into the pleural space [PMID:7075317].
Clinical Presentation
Nine cases of late-onset empyema after pneumonectomy presented with prolonged illness durations, often several months, before diagnosis [PMID:867326].
Diagnosis
In four cases, the presence of gas in the hemithorax led to the diagnosis of empyema, with some cases involving bronchial or esophageal fistulae [PMID:867326].
Management
All patients except one were treated initially with rib resection and open drainage, resulting in survival for all, and successful closure of drainage sinuses in most cases without fistulae [PMID:867326].
In our experience, decortication within 2 days for patients not responding to medical treatment yielded excellent results with rapid recovery [PMID:9016468].
All patients who required decortication made uneventful postoperative recoveries, highlighting the safety and efficacy of this approach in skilled surgical settings [PMID:9016468].
Resolution of Aspergillus empyema was achieved through drainage procedures and removal of the implicated silk suture [PMID:7075317].
Complications
Although not explicitly detailed, the case highlights potential complications like fistula formation when infection extends from bronchial stumps into the pleural space [PMID:7075317].
Special Populations
Four out of twenty patients were found to have significant immunological defects, underscoring the importance of screening for such conditions [PMID:9016468].
References
1 Kerr WF. Late-onset post-pneumonectomy empyema. Thorax 1977. link 2 Khakoo GA, Goldstraw P, Hansell DM, Bush A. Surgical treatment of parapneumonic empyema. Pediatric pulmonology 1996. link1099-0496(199612)22:6<348::AID-PPUL3>3.0.CO;2-F) 3 Parry MF, Coughlin FR, Zambetti FX. Aspergillus empyema. Chest 1982. link