Background: Chronic empyema thoracis is a debilitating illness with high morbidity and mortality, and is seen among all age groups in Nigeria. Objective: To review all cases of chronic empyema thoracis treated by pleurectomy and lung decortication and highlight the indications, challenges and the outcome. Materials and Method: In a 10-year period spanning 2007-2016, 90 patients with chronic empyema thoracis were admitted and managed in our institution. A retrospective study of 36 patients who underwent surgery was performed. Results: Ten patients (27.80%) out of 36 patients had unsuccessful one month closed chest tube drainage (CTTD). Six patients (16.67%) were referred from peripheral hospitals as chronic empyema thoracis that had failed CTTD. The remainder, 20 (55.60%) were diagnosed as chronic empyema thoracis de novo. Conclusion: Chronic empyema thoracis is a very difficult disease to manage especially in developing countries like ours, where patients present very late and the requisite facilities are inadequate.

Subclavian artery pseudoaneurysms are rare and occur mostly as a consequence of an inadvertent arterial puncture during central venous catheterization, endovascular therapeutic procedures or after penetrating or blunt trauma. They usually have a late clinical presentation, with pain, swelling or other compressive symptoms. We present a 40-year old man farmer who presented to our service with prior 14 days and 12 days history of left chest upper chest swelling and inability to use the left upper limb respectively, all on account of injury. He went on a night alcohol binge, got drunk and while getting to his sitting room slipped and fell on a nearby glass center table. He had a deep cut on the left upper anterior chest wall. There was immediate profuse spurting bleeding with estimated blood loss of 800 ml. After delay in definitive treatment due to financial constraint the aneurysm increased in size, ruptured and rebled profusely leading to syncope. He was managed by Doppler ultrasound, median sternotomy and subclavian artery exploration to achieve proximal and distal vascular control. Sac was entered into via an infraclavicular transverse incision, heamatoma manually evacuated, bleeding site isolated and secured. He received 5 units of blood. Postoperative course was uneventful as he was managed with analgesics, antibiotics, haematinics and physiotherapy. Power in the upper limb has improved to 3 around the shoulder, 2 around the elbow and 1 around the wrist.