Download PDF
Semin intervent Radiol 2003; 20(3): 243-250
DOI: 10.1055/s-2004-815575
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Thoracic Infections and Drainage

Simeon Abramson1 , Debra A. Gervais1,2
  • 1Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
  • 2Assistant Professor of Radiology
Further Information

Publication History

Publication Date:
15 January 2004 (online)

Also available at
    Permissions and Reprints

ABSTRACT

After a short review of background information of lung abscess, including the importance of distinguishing a lung abscess from empyema, we discuss the indications for image-guided intervention. The technique followed by results are then detailed. We also review the indications, technique, and results of percutaneous management of empyemas and include a discussion of both the Seldinger and trocar techniques as well as the use of fibrinolytic therapy.

KEYWORDS

Lung abscess - empyema - intervention - fibrinolytics

REFERENCES

  • 1 Klein J S, Schultz S, Heffner J E. Interventional radiology of the chest: image-guided percutaneous drainage of pleural effusions, lung abscess and pneumothorax.  AJR Am J Roentgenol . 1995;  164 581-588
    PubMedSearch in Google Scholar
  • 2 Mwandumba H C, Beeching N J. Pyogenic lung infections: factors for predicting clinical outcome of lung abscess and thoracic empyema.  Curr Opin Pulm Med . 2000;  6 234-239
    CrossrefPubMedSearch in Google Scholar
  • 3 Stark D D, Federle M P, Goodman P C, Podrasky A E, Webb W R. Differentiating lung abscess and empyema: radiography and computed tomography.  AJR Am J Roentgenol . 1983;  141 163-167
    PubMedSearch in Google Scholar
  • 4 Yang P-C, Luh K-T, Lee Y-C. et al . Lung abscesses: US examination and US-guided transthoracic aspiration.  Radiology . 1991;  180 171-175
    CrossrefPubMedSearch in Google Scholar
  • 5 Weissberg D. Percutaneous drainage of lung abscess.  J Thorac Cardiovasc Surg . 1984;  87 308-312
    PubMedSearch in Google Scholar
  • 6 Yellin A, Yellin E O, Lieberman Y. Percutaneous tube drainage: the treatment of choice for refractory lung abscess.  Ann Thorac Surg . 1985;  39 266-270
    CrossrefPubMedSearch in Google Scholar
  • 7 Estrera A S, Platt M R, Mills L J, Shaw R R. Primary lung abscess.  J Thorac Cardiovasc Surg . 1980;  79 275-282
    CrossrefPubMedSearch in Google Scholar
  • 8 Hagan J L, Hardy J D. Lung abscess revisited. A survey of 184 cases.  Ann Surg . 1983;  197 755-762
    CrossrefPubMedSearch in Google Scholar
  • 9 Hoffer F A, Bloom D A, Colin A A, Fishman S J. Lung abscess versus necrotizing pneumonia: implications for interventional therapy.  Pediatr Radiol . 1999;  29 87-91
    CrossrefPubMedSearch in Google Scholar
  • 10 vanSonnenberg E, D'Agostino H B, Casola G, Wittich G R, Varney R R, Harker C. Lung abscess: CT-guided drainage.  Radiology . 1991;  178 347-351
    PubMedSearch in Google Scholar
  • 11 Erasmus J J, McAdams P, Rossi S, Kelley M L. Percutaneous management of intrapulmonary air and fluid collections.  Radiol Clin North Am . 2000;  38 385-393
    CrossrefPubMedSearch in Google Scholar
  • 12 Silverman S G, Mueller P R, Saini S. et al . Thoracic empyema: management with image-guided catheter drainage.  Radiology . 1988;  169 5-9
    CrossrefPubMedSearch in Google Scholar
  • 13 Mueller P R, Berlin L. Complications of lung abscess aspiration and drainage.  AJR Am J Roentgenol . 2002;  178 1083-1086
    CrossrefPubMedSearch in Google Scholar
  • 14 Ha H K, Kang M W, Park J M, Yang W J, Shinn K S, Bahk Y W. Lung abscess: percutaneous catheter therapy.  Acta Radiol . 1993;  34 362-365
    CrossrefPubMedSearch in Google Scholar
  • 15 Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer M R. Factors predicting mortality of patients with lung abscess.  Chest . 1999;  115 746-750
    CrossrefPubMedSearch in Google Scholar
  • 16 Irwin R S, Garrity F L, Erickson A D, Corrao W M, Kaemmerlen J T. Sampling lower respiratory tract secretions in primary lung abscess: a comparison of the accuracy of four methods.  Chest . 1981;  79 559-565
    PubMedSearch in Google Scholar
  • 17 Light R W. Parapneumonic effusions and empyema.  Clin Chest Med . 1985;  6 55-62
    PubMedSearch in Google Scholar
  • 18 Lemmer J H, Botham M J, Orringer M B. Modern management of adult thoracic empyema.  J Thorac Cardiovasc Surg . 1985;  90 849-855
    PubMedSearch in Google Scholar
  • 19 LeBlanc K A, Tucker W Y. Empyema of the thorax.  Surg Gynecol Obstet . 1984;  158 66-70
    PubMedSearch in Google Scholar
  • 20 Pezzella A T, Walls J T, Curtis J J. Nontuberculous empyema: a clinical experience.  Tex Heart Inst J . 1983;  10 263-268
    PubMedSearch in Google Scholar
  • 21 Mavroudis C, Symmonds J B, Minagi H, Thomas A N. Improved survival in management of empyema thoracis.  J Thorac Cardiovasc Surg . 1981;  82 49-57
    PubMedSearch in Google Scholar
  • 22 O'Moore P V, Mueller P R, Simeone J F. et al . Sonographic guidance in diagnostic and therapeutic interventions in the pleural space.  AJR Am J Roentgenol . 1987;  149 1-5
    PubMedSearch in Google Scholar
  • 23 Moulton J S. Image-guided management of complicated pleural fluid collections.  Radiol Clin North Am . 2000;  38 345-374
    CrossrefPubMedSearch in Google Scholar
  • 24 Goldberg M A, Mueller P M, Saini S. et al . Importance of daily rounds by the radiologist after interventional procedures of the abdomen and chest.  Radiology . 1991;  180 767-770
    PubMedSearch in Google Scholar
  • 25 Strange C, Sahn S A. The clinician's perspective on parapneumonic effusions and empyema.  Chest . 1993;  103 259-261
    PubMedSearch in Google Scholar
  • 26 Bergh N P, Ekroth R, Larsson S, Nagy P. Intrapleural streptokinase in the treatment of haemothorax and empyema.  Scand J Thorac Cardiovasc Surg . 1977;  11 265-268
    PubMedSearch in Google Scholar
  • 27 Sharma G R K V, Cella G, Parisi A F, Sasahara A A. Thrombolytic therapy.  N Engl J Med . 1982;  306 1268-1276
    PubMedSearch in Google Scholar
  • 28 Huang H-C, Chang H-Y, Chen C-W, Lee C-H, Hsiue T-R. Predicting factors for outcome of tube thoracostomy in complicated parapneumonic effusion or empyema.  Chest . 1999;  115 751-756
    CrossrefPubMedSearch in Google Scholar
  • 29 Merriam M A, Cronan J J, Dorfman G S, Lambiase R E, Haas R A. Radiologically guided percutaneous catheter drainage of pleural fluid collections.  AJR Am J Roentgenol . 1988;  151 1113-1116
    PubMedSearch in Google Scholar
  • 30 Jerjes-Sanchez C, Ramirez-Rivera A, Elizalde J J. Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial.  Chest . 1996;  109 1514-1519
    PubMedSearch in Google Scholar
  • 31 Waller D A, Rengarajan A. Thoracoscopic decortication: a role for video-assisted surgery in chronic postpneumonic pleural empyema.  Ann Thorac Surg . 2001;  71 1813-1816
    CrossrefPubMedSearch in Google Scholar
  • 32 Lim T K, Chin N K. Empirical treatment with fibrinolysis and early surgery reduces the duration of hospitalization in pleural sepsis.  Eur Respir J . 1999;  13 514-518
    CrossrefPubMedSearch in Google Scholar
  • 33 Temes T R, Follis F, Kessler R M, Pett S B, Wernly J A. Intrapleural fibrinolytics in management of empyema thoracis.  Chest . 1996;  110 102-106
    CrossrefPubMedSearch in Google Scholar
  • 34 Moulton J S, Benkert R E, Weisiger K H, Chambers J A. Treatment of complicated pleural fluid collections with image-guided drainage and intracavitary urokinase.  Chest . 1995;  108 1252-1259
    CrossrefPubMedSearch in Google Scholar
  • 35 Ashbaugh D G. Empyema thoracis: factors influencing morbidity and mortality.  Chest . 1991;  99 1162-1165
    CrossrefPubMedSearch in Google Scholar
  • 36 Orringer M B. Complications of esophageal resection and reconstruction. In: Waldhausen JA, Orringer MB, eds. Complications in Cardiothoracic Surgery St. Louis, MO: Mosby 1991: 354-369
    Search in Google Scholar
  • 37 Maher M M, Lucey B C, Boland G, Gervais D A, Mueller P R. The role of interventional radiology in the treatment of mediastinal collections caused by esophageal anastomatic leaks.  AJR Am J Roentgenol . 2002;  178 649-653
    PubMedSearch in Google Scholar