Latorzeff I, Berjaud J, Aziza R, Arboucalot F, Giron J, Dahan M, Bachaud J M
Département de radiothérapie, institut Claudius-Regaud, Toulouse, France.
Cancer Radiother. 1999 Nov-Dec;3(6):508-12. doi: 10.1016/s1278-3218(00)88259-1.
Following a pneumonectomy for cancer, the patients are classically observed by clinical examination and standard chest X-ray. However, torpid empyemas can be missed when they occur after the period of hospitalization and when they are not accompanied by a fever. At the time of postoperative radiotherapy, the dosimetric CT scan constitutes the first examination providing objective information of the endothoracic content. It is therefore necessary on this occasion to assure the normality of the postpneumonectomy pleural space while checking that the substituted liquid is homogeneous and above all that the internal mediastinal part of the cavity has a concave appearance. If that is not the case, an empyema should be suspected. The diagnosis, confirmed by a cytobacteriological examination of the pleural fluid, constitutes a counterindication of the radiotherapy. We present two cases of postpneumonectomy paucisymptomatic empyema which were diagnosed during the course of postoperative radiotherapy when the initial dosimetric CT scan was pathologic and could have allowed an earlier diagnosis.
对于因癌症行肺切除术后的患者，传统上是通过临床检查和标准胸部X线进行观察。然而，隐匿性脓胸在住院期后发生且不伴有发热时可能会被漏诊。在术后放疗时，剂量测定CT扫描是提供胸内情况客观信息的首要检查。因此，此时有必要确保肺切除术后胸膜腔正常，同时检查替代液体是否均匀，最重要的是检查胸腔内纵隔部分是否呈凹形。如果不是这种情况，则应怀疑有脓胸。经胸腔积液细胞细菌学检查确诊的脓胸是放疗的禁忌证。我们报告两例肺切除术后症状轻微的脓胸病例，这两例脓胸是在术后放疗过程中，初始剂量测定CT扫描显示异常时被诊断出来的，而这种异常本可使更早诊断成为可能。
