الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Despite the advances in antibiotic therapy during the last decades, thoracic empyema remains a common clinical entity with significant associated morbidity and mortality. This should be attributed to the rise of antibiotic- multi resistant infections, to the increased frequency of nosocomial pneumonias and to the treatment of a wider population with immune deficiencies.
At least 40% of all patients diagnosed with pneumonia will have an associated pleural effusion, although the minority of these will require active intervention. A parapneumonic pleural effusion refers to any effusion secondary to pneumonia or lung abscess. It becomes complicated when an invasive procedure is necessary for its resolution, or if bacteria can be cultured from the effusion. Empyema literally refers to frank pus in the pleural space.
The treatment options for parapneumonic effusions range from noninvasive antibiotic therapy and observation, to semi-invasive techniques such as therapeutic aspiration, tube thoracostomy and intrapleural fibrinolytics, to invasive interventions such as thoracoscopy, thoracotomy or open drainage.
Thoracoscopy remains a treatment option for the patient with an incompletely drained loculated parapneumonic effusion, provided that it is performed early in the disease and that the pleural anatomy is defined by means of either ultrasonography or computed tomography. Loculations can be broken down, the visible pleural space completely drained, and an intercostal chest tube can be optimally placed. Furthermore, visual inspection of the pleura may guide decisions regarding the need for an open surgical procedure.
The study included 40 patients having empyema attending the department of chest diseases of Alexandria Main University Hospital.