Empyema complicating closed intrapleural pneumonolysis and artificial pneumothorax.

Despite many viscissitudes, pneumothorax is still the most important collapse measure in pulmonary tuberculosis. Its accessory procedure, closed intrapleural pneumonolysis, has increased greatly in usefulness and popularity and is considered to have very few complications. The most important one is tuberculous empyema which, in various published series’’#{176} ranges from zero to 26 per cent with a median range of 4 to 8 per cent. The great majority of these figures is based upon postoperative observation of from one to four months. The occurrence of empyema beyond this time is assumed to be due to nonoperative causes. According to Alexander,2 some surgeons “do not consider even a pleuro-pulmonary perforation with a mixed infection empyema as a postoperative complication if it occurs more than a month or two after operation.” He also states that “the incidence of serious postoperative complications is almost in direct ratio to the shortness of the adhesion divided and in inverse ratio to the experience, skill, and patience of the surgeon.” In this study it will be shown: (1) that other factors contributing to empyema formation include several features of the adhesions and certain parenchymal characteristics, (2) that the empyema rate varies directly with the difficulty of the operation, (3) that the empyema rate is higher than generally supposed, and (4) that from the empyema standpoint there is no definite postoperative period limited to three months but an indefinite one limited only by the duration of the pneumothorax.