Treatment of Tuberculous Empyema by Intrathoracic Transposition of a Latissimus Dorsi Muscle Flap.

117 South Korea has the highest prevalence of tuberculosis among the Organization for Economic Cooperation and Development nations [1], despite the management of pulmonary tuberculosis with antituberculosis drugs. Therefore, South Korea also has a relatively high prevalence of tuberculous empyema, a complication of tuberculosis that accounts for 3%–6% of all cases of empyema [2]. A chronic, active infection of the pleural space, tuberculous empyema is a refractory disease requiring long-term medication and drainage [3]. We report our success in transposing the latissimus dorsi (LD) muscle into the pleural space in order to prevent the recurrence of tuberculous empyema. In 2012, a 53-year-old male patient diagnosed with pulmonary tuberculosis recovered completely after receiving treatment. However, he experienced recurrence of pulmonary tuberculosis in 2014, and during treatment, a computed tomography (CT) image revealed that the right lower lobe of his lung had collapsed. This led to the occurrence of tuberculous empyema, and the patient was hospitalized to undergo thoracic surgery to treat the empyema. The patient’s condition did not improve during the operation, despite the continuous administration of medication and chest tube drainage. The thoracic surgeon therefore performed a lung lobectomy with decortication, and we decided to transpose the LD muscle flap into the resulting cavity (Fig. 1). We first identified the pleural space on the chest CT image and calculated the approximate volume of the space (203 cm). The flow of the thoracodorsal artery was determined using a pencil Doppler and the latissimus border was outlined with a marker. After determining the amount of LD muscle required, we determined the necessary incision length and drew the incision lines (Fig. 2). The incision started in the Treatment of Tuberculous Empyema by Intrathoracic Transposition of a Latissimus Dorsi Muscle Flap