Volume 14, Supplement 1
Original Article / Published: April 2026
DOI: https://www.doi.org/10.57045/jemis/1410426.pp24-25
S. Amiri, N. Tsonevski, V. Yordanov, T. Badarov, A. Dimitrova
Clinic of Thoracic Surgery – MMA “MPHAT – Sofia”
Abstract
Pleural empyema is a complex clinical condition characterized by the accumulation of pus in the pleural cavity. Chronicity leads to thickening of the visceral pleura and permanent impairment of respiratory function. The most common site for the development of pleural empyema is uncomplicated parapneumonic effusions – observed in about 50% of bacterial pneumonias. Other causes are: infection from a source bordering the pleural space (50-60%), direct infection of the pleural space (30-40%), hematogenous infection of the pleural space (1%).
Diagnosis of pleural empyema includes: physical examination, chest X-ray, chest ultrasound, chest CT scan and diagnostic thoracocentesis. Today, the treatment of acute empyema is carried out by performing videothoracoscopy- complete evacuation of pus, rupturing the separating fibrin barriers, adhesiolysis, removal of fibrin deposits from the surface of the lung, placement of the pleural drainage in an optimal position under video control, combined with antibiotic therapy according to the anti-biogram, respiratory rehabilitation and active physiotherapy. In patients with contraindications for undergoing full anesthesia, a thoracostomy is performed. In chronic empyema, videothoracoscopy is performed for evacuation of the purulent collection, debridement, lavage and intraoperative assessment of the volume of the empyema cavity and rigidity of the visceral pleura (assessment of the potential for expansion of the “armored” lung without decortication). In case of elastic visceral pleura and small volume of the empyema cavity, the chest drain is left longer /weeks/ with a Heimlich valve for gradual expansion of the “armored” lung and complete obliteration of the pleural cavity. In case of rigid visceral pleura and large empyema cavity – pulmonary VATS decortication. Thoracotomy for pulmonary decortication is performed less and less frequently and is giving way to minimally invasive surgical techniques.
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How to cite this article:
S. Amiri, N. Tsonevski, V. Yordanov, T. Badarov, A. Dimitrova. Modern surgical treatment of pleural empyema. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2026; 14(1): 24-25
Corresponding author:
D-r Sabrina Amiri
Email: sabrinaa995@gmail.com
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