Surgery in tuberculous and post tuberculous empyema

Tuberculous and post-tuberculous empyema is not a common problem In selected cases surgical intervention is mandatory. We retrospectively reviewed our experience over 2 years (between January 1996 till January 1998) with dealing with tuberculous empyema. There were 21 patients ( 19 male and 2 female) with an average age of 34.1 years (range between 18 and 61 years). The empyema was right sided in 11, left in 9 and bilateral in one patient. Patients presented with respiratory symptoms for a mean duration of 4.43 months (range between 1 and 48 months). The development of empyema was either at presentation (n = 9) or after diagnosis of tuberculosis (n = 12) with a mean duration of 50.3 days (range between 0 and 720 days). At diagnosis 17 patients had positive cultures for tuberculosis in the sputum (81%). The diagnosis was made utilising chest radiography with or without computerised scan of the chest, followed by needle aspiration to confirm the presence of pus rather than effusion. The aspirate was positive for tuberculosis in 17 patients (81%). Surgical treatment included insertion of an intercostal drain only in 16, thoracoscopic drainage in 2, and aspiration in 3 patients. Additional installation of Streptokinase was performed in 3, and formal thoracotomy with decortication in 4. One patient required a window and another pneumonectomy with thoracoplasty. The duration of drainage varied from 1 to 120 days (mean of 30.1 days). Anti-tuberculous treatment was given for a mean of 8.3 months ( range between 6 and 16 months). There was no mortality and all patients were fully recovered with no further evidence of the disease. Surgical treatment for tuberculous empyema is rarely required. Selection of the surgical approach for each individual case should be toward cure with the least invasive method.