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We present three cases of postoperative empyema after pulmonary resection: case 1, acute empyema without fistula after lobectomy and chest wall resection; case 2, continuing empyema with fistula and total left residual lung abscess after upper divisionectomy; and case 3, chronic empyema with middle lobe bronchopleural fistula after lower lobectomy. Pedicle skeletal muscle plombage into the cavity, thoracoplasty, and continuous cavity ablution with 24-h instillation of minocycline and saline solution through drains were used for treatment. In case 2, a completion extrapleural left pneumonectomy was concurrently performed. In all three cases, the surgery was successful; however, case 2 developed a massive gastrointestinal hemorrhage, which led to blood aspiration pneumonitis, renal failure, and death. Muscle plombage effectively achieves the closure of empyema cavity and thoracoplasty complements this. When a residual space remains, cavity ablution is considered to be effective. However, concurrent completion lung parenchyma resection might be excessively aggressive.

journal of thoracic disease

Surgical treatment of empyema after pulmonary resection using pedicle skeletal muscle plombage, thoracoplasty, and continuous cavity ablution procedures: a report on three cases