Correct!
3. VATS with plan for possible thoracotomy
The CT scan confirms the complex nature of the pleural fluid with what appears to be a rind surrounding the effusion. It is unlikely that a repeat thoracentesis will yield different results than the first attempt. There does not appear to be any bronchial pathology so bronchoscopy is not indicated. Therefore, the best option appears to be VATS with possible conversion to a thoracotomy.
At the time of thoracotomy an extensive pleural peel was noted consistent with empyema (Figure 5). A conversion from VATS to thoracotomy was required to remove the peel.
Figure 5. Thorascopic views of right pleural space showing an extensive peel around the right lung.
Histopathology of the pleura showed chronic inflammation but no organisms were identified on pathology or culture.
Empyema or complicated parapneumonic effusions should be managed with which of the following? (Click on the correct answer to be directed to the seventh and final page)