Complicated Parapneumonic Effusion: Etiology and Results of Lung Decortication

Parapneumonic effusion is a common accompaniment of bacterial pneumonia and mostly isresolved with medical management. we studied the etiology and possible underlying causes ofcomplicated parapneumonic effusion and timing of pulmonary decortication. a descriptive study on 34patients with postpneumonic empyema which required decortication carried out. post surgical and posttraumatic empyema were excluded. patients’ age ranged from 20 to 75 with a mean of 46 years. themost common clinical findings were fever (90%), pleural dull pain (80%), productive cough (73%) anddyspnea (70%). ppd test was negative in all patients. in 78%, white cell count was normal; inremainder it was more than 10.000. bacteriological findings were negative and acid fast bacilli were notdetected. all patients underwent posterolateral thoracotomy and decortication and completelyexpansible lung was achieved. tissue diagnosis after decorticating showed tuberculosis in 8 (24%)patients and necrotic tissue in remainder. average medical management time and postoperative hospitalstay were 38± 2 and 6.7 ± 2 days, respectively. morbidity rates were acceptable and there was one latemortality. no recurrence was happened. in parapneumonic effusions not responding to standardtreatment, tuberculosis must be considered, especially in addicted persons, positive family history andesr >100. in complicated parapneumonic effusion, early thoracotomy and full decortication isrecommend because it is diagnostic, allows control of infection, releases the pulmonary entrapment,early discharge from hospital, need not further antibiotic administration and is cost benefit.