Excision of Empyema and Decortication of the Lung

Pleural infection may result from sepsis within the lung or the chest wall, from penetrating wounds or transdiaphragmatic spread from the abdomen (i.e. liver abscess). Early acute infections may resolve with systemic antibiotics and simple tube drainage. Recently tube drainage followed by fibrinolysis has been shown to be effective. Chronic empyemas, however, need surgical attention if conservative methods fail. An empyema is commonly referred to as chronic after being present for 6 weeks. A tuberculous empyema is now unusual, and pneumonia is now the most common cause.