What is the role of a medical thoracoscopy (pleuroscopy) in the treatment of empyema and complicated parapneumonic effusions?

Updated: Apr 18, 2019
  • Author: Rajiv Malhotra, DO, MS, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Empyema and Complicated Parapneumonic Effusions

Some interventional pulmonologists have used medical thoracoscopy for drainage of uncomplicated empyema and chest tube placement. Additionally, it can be used carefully for lysis of thin fibrous adhesions (see the image below). [12]

Pleural adhesions on medical thoracoscopy. Pleural adhesions on medical thoracoscopy.

Currently, this is not routinely performed or the standard of care, mainly because timing is key in these procedures and they should be considered early if chest tube drainage is inadequate. [5, 13] In later phases of the empyema, there may be thick fibrous adhesions, pleural peel, or trapped lung. In these cases, early video-assisted thoracoscopic decortication is required. [14, 15]


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