Sonographic septation: a useful prognostic indicator of acute thoracic empyema.

Abstract

The aim of this study was to identify sonographic predictors of patient outcomes or need for surgical intervention of acute thoracic empyema. All patients with a clinical diagnosis of thoracic empyema underwent transthoracic ultrasonographic examination and thoracentesis at admission. According to the presence or absence of septa in sonographic images, the patients were classified into two groups: septated and nonseptated. Sonographic findings were analyzed with respect to duration of hospital stay, chest tube drainage, and treatment efficacy. A total of 163 consecutive patients were included in the study (83 patients with septated and 80 with nonseptated sonographic images). The mean duration of hospital stay (35.4 versus 27.0 days, P = 0.009) and chest tube drainage (13.1 versus 7.6 days, P < 0.001) for the patients with septa were significantly longer than for those without septa. The patients with septa were more likely to undergo intrapleural fibrinolytic therapy (63.8% versus 38.8%, odds ratio 2.79, P = 0.001) and surgical intervention (24.3% versus 7.5%, odds ratio 3.92, P = 0.004). We concluded that sonographic septation is a useful sign to predict the need for subsequent intrapleural fibrinolytic therapy and surgical intervention in cases of acute thoracic empyema. Early fibrinolytic therapy or even surgical intervention may be indicated in patients with sonographic septations.

A practical guide to transthoracic ultrasound

“…3) has clinical implications. Several studies have shown that patients with septated effusions needed longer chest tube drainage, longer hospital care and were more likely to require fibrinolytic therapy or surgery compared to those with non-septated effusions [18,19].…”

“…Moreover, the risk of pneumothorax following aspirations is reduced, irrespective of the size of the effusion [21]. Depending on operator experience, ultrasonography may also guide further decisions regarding the need for tube drainage, intrapleural fibrinolytic therapy, pleuroscopy or surgical intervention [22].…”

Sonographic Septation in Lymphocyte-Rich Exudative Pleural Effusions

“…As reported, tuberculous pleural effusions and empyema commonly had complex septated sonographic appearances. 6,[13][14][15] However, the differentiation between empyema and tuberculosis is easily made. Therefore, our objective was to focus on the lymphocyte-rich exudative pleural effusions.…”

Pleural Empyema Menagement: A Brief Review of Litterature

“…Existing data are mixed. In an unblinded trial, the presence of sonographic septations was predictive of more aggressive treatment, but did not specifically address the success or failure of tube drainage in this population (19).…”