Empyema is a condition characterized by the accumulation of pus within the pleural space, which is the area between the lung and the inner surface of the chest wall. It is often a complication of an existing infection, most commonly pneumonia. Causes include bacterial pneumonia, lung abscess, chest surgery or trauma, and other infections. Symptoms of right-sided empyema often resemble those of pneumonia but can be more persistent or severe. Symptoms include high and persistent fever, sharp and pleuritic chest pain, cough, shortness of breath, sweats, fatigue, malaise, and weight loss in chronic cases. Diagnosis involves a combination of clinical evaluation and imaging studies such as chest X-ray, CT scan, ultrasound, and pleural fluid analysis. The definitive diagnostic test is pleural fluid analysis, which confirms the diagnosis of empyema. Early diagnosis and appropriate treatment are crucial for managing right-sided empyema and preventing complications such as lung scarring or sepsis.
Treatment for empyema involves antibiotics, drainage, and fibrinolytic therapy. If the empyema is fibrothorax, fibrinolytic medications can be instilled through the chest tube to improve drainage. If the empyema progresses to a more chronic stage, surgery may be necessary. The primary surgical procedure is decortication, which removes the fibrous peel from the lung surface. Two main approaches are video-assisted thoracoscopic surgery (VATS) decortication and open thoracotomy with decortication. VATS is preferred for its smaller incisions, shorter hospital stay, and reduced risk of complications. Open thoracotomy with decortication is necessary in cases of complex or extensive empyemas, significant lung damage, or failed VATS decortication.
Mr. Reeshab Kar from West Bengal successfully underwent Decortication of Right-Sided Empyema at Yashoda Hospitals, Hyderabad, under the supervision of Dr. Viswesvaran Balasubramanian, Consultant Interventional Pulmonology and Sleep Medicine.
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