Mainali Sumina, Yadav Binay, Koju Naman, Karki Aashish, K C Narendra, Bista Dhanupa
Kathmandu University School of Medical Sciences, Dhulikhel, Kavre.
Ann Med Surg (Lond). 2023 Jun 20;85(8):4112-4117. doi: 10.1097/MS9.0000000000001014. eCollection 2023 Aug.
Empyema thoracis is a condition characterized by the accumulation of pus in the pleural cavity of the lungs. Empyema thoracis is a cause of high mortality in man and its occurrence is increasing in both children and adults. Traditionally, chest tube drainage has been a preferred method of treatment, but recent studies have shown that pigtail catheter drainage is a more effective and less invasive alternative. Image-guided drainage is also preferred over blind drainage, and alternative drainage sites are being explored. These management changes have improved patient outcomes and reduced the risk of complications.
A 66-year-old female presented with complaints of cough, fever, and chest pain. A clinical examination was done and relevant investigations were sent. She was then treated in the line of left-sided empyema thoracis. A pigtail catheter was inserted into the loculated empyema via the left 9th intercostal space through a posterolateral approach with ultrasonography guidance.
The main aim of this article is to provide an overview of a rare management approach for empyema, a condition characterized by the accumulation of pus in the pleural cavity of the lungs. In this case report, the authors have focused on pigtail catheter drainage over traditionally performed chest tube drainage, and image-guided drainage has been performed over blind drainage ensuring accurate placement and reducing the risk of damage to surrounding tissues. Another notable change in empyema management is the shift in drainage sites from the safety triangle to other sites based on the site of loculations under ultrasonography guidance.
脓胸是一种以肺胸膜腔内积聚脓液为特征的病症。脓胸是人类高死亡率的一个原因,其在儿童和成人中的发生率都在上升。传统上,胸腔闭式引流一直是首选的治疗方法,但最近的研究表明,猪尾导管引流是一种更有效且侵入性更小的替代方法。影像引导下的引流也优于盲目引流,并且正在探索其他引流部位。这些管理上的改变改善了患者的治疗效果并降低了并发症的风险。
一名66岁女性因咳嗽、发热和胸痛前来就诊。进行了临床检查并送检了相关检查项目。随后她按照左侧脓胸进行治疗。在超声引导下,通过后外侧入路经左侧第9肋间间隙将一根猪尾导管插入包裹性脓胸中。
本文的主要目的是概述一种针对脓胸的罕见管理方法,脓胸是以肺胸膜腔内积聚脓液为特征的病症。在本病例报告中,作者重点介绍了相对于传统的胸腔闭式引流的猪尾导管引流,并且采用了影像引导下的引流而非盲目引流,以确保准确放置并降低对周围组织造成损伤的风险。脓胸管理中的另一个显著变化是,在超声引导下,根据包裹部位,引流部位从安全三角区转移到了其他部位。