Evaluation of Decortication in Patients with Chronic Tuberculous Empyema by Three-Dimensional Computed Tomography Densitometry

Abstract

Background Decortication for chronic pleural empyema (CPE) is to restore lung volume by removing empyema sac and thickened pleura. Extent of lung volume restoration after decortication has been undefined. This study aims to evaluate lung volume restoration using densitometry with three-dimensional reconstruction computed tomography (CT).

Methods We studied 23 patients with CPE who underwent decortication and follow-up CT. CT and pulmonary function test (PFT) were evaluated at a median of 19.1 months postoperatively. The volumes of operated and nonoperated lung were measured by pre- and postoperative CT-densitometry. Preoperative and postoperative values of lung volumes, PFTs, and thoracic asymmetry rates were compared statistically.

Results The mean preoperative volumes of operated and nonoperated lung were 1,239 and 2,094 mL, respectively and 1,848 and 2,311 mL postoperatively. The postoperative lung expansion rate was 71% on the operated side (p < 0.001) and 15% on the nonoperated side (p = 0.026). The mean improvement rate of total lung volume was 31%. The postoperative value of forced vital capacity, forced expiratory volume during 1 second and lung diffusion capacity of carbon monoxide improved 28.0%, 27.4% (p < 0.001), and 17.9% (p < 0.012), respectively. The thoracic asymmetry decreased from 4.3% before surgery to 2.8% after surgery (p = 0.026).

Conclusions With the use of CT-densitometry, we quantified the changes of each lung volume. Decortication for CPE can improve re-expansion of diseased and healthy lung. Improvement of nonoperated lung may be due to the overall improvement of chest wall elasticity. Coincidentally, we discovered that the improvement of total lung volume was positively associated with the improvement of PFT after decortication.

Keywords

empyema - pleural disease (incl. drainage) - pulmonary function

• References

• 1 Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc 2006; 3 (1) 75-80
• 2 Rzyman W, Skokowski J, Romanowicz G, Lass P, Dziadziuszko R. Decortication in chronic pleural empyema - effect on lung function. Eur J Cardiothorac Surg 2002; 21 (3) 502-507
• 3 Chan DT, Sihoe AD, Chan S , et al. Surgical treatment for empyema thoracis: is video-assisted thoracic surgery “better” than thoracotomy?. Ann Thorac Surg 2007; 84 (1) 225-231
• 4 Choi SS, Kim DJ, Kim KD, Chung KY. Change in pulmonary function following empyemectomy and decortication in tuberculous and non-tuberculous chronic empyema thoracis. Yonsei Med J 2004; 45 (4) 643-648
• 5 Casali C, Storelli ES, Di Prima E, Morandi U. Long-term functional results after surgical treatment of parapneumonic thoracic empyema. Interact Cardiovasc Thorac Surg 2009; 9 (1) 74-78
• 6 Nakaoka K, Nakahara K, Iioka S, Mori T, Sawamura K, Kawashima Y. Postoperative preservation of pulmonary function in patients with chronic empyema thoracis: a one-stage operation. Ann Thorac Surg 1989; 47 (6) 848-852
• 7 Kim DJ, Im JG, Goo JM, Lee HJ, You SY, Song JW. Chronic tuberculous empyema: relationships between preoperative CT findings and postoperative improvement measured by pulmonary function testing. Clin Radiol 2005; 60 (4) 503-507
• 8 Gokce M, Okur E, Baysungur V, Ergene G, Sevilgen G, Halezeroglu S. Lung decortication for chronic empyaema: effects on pulmonary function and thoracic asymmetry in the late period. Eur J Cardiothorac Surg 2009; 36 (4) 754-758
• 9 Swoboda L, Laule K, Blattmann H, Hasse J. Decortication in chronic pleural empyema. Investigation of lung function based on perfusion scintigraphy. Thorac Cardiovasc Surg 1990; 38 (6) 359-361
• 10 Park KJ, Bergin CJ, Clausen JL. Quantitation of emphysema with three-dimensional CT densitometry: comparison with two-dimensional analysis, visual emphysema scores, and pulmonary function test results. Radiology 1999; 211 (2) 541-547
• 11 Swoboda L, Laule K, Blattmann H, Hasse J. [Improving function by decortication. Functional studies with particular evaluation of lung perfusion scintigraphy]. Helv Chir Acta 1991; 57 (4) 631-636
• 12 Magdeleinat P, Icard P, Pouzet B, Farès E, Regnard JF, Levasseur P. [Current indications and results of pulmonary decortication for nontuberculous chronic empyema]. Ann Chir 1999; 53 (1) 41-47
• 13 Cardillo G, Carleo F, Carbone L , et al. Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortication. Eur J Cardiothorac Surg 2009; 36 (5) 914-918
• 14 Tong BC, Hanna J, Toloza EM , et al. Outcomes of video-assisted thoracoscopic decortication. Ann Thorac Surg 2010; 89 (1) 220-225
• 15 Chambers A, Routledge T, Dunning J, Scarci M. Is video-assisted thoracoscopic surgical decortication superior to open surgery in the management of adults with primary empyema?. Interact Cardiovasc Thorac Surg 2010; 11 (2) 171-177
• 16 Ilic N. Functional effects of decortication after penetrating war injuries to the chest. J Thorac Cardiovasc Surg 1996; 111 (5) 967-970