Correct!
5. Any of the above
The diagnosis of empyema requires demonstration of organisms or pus in the pleural space. A complicated parapneumonic effusion shows a pleural fluid pH < 7.20, but without organisms. Either a parapneumonic effusion or an empyema become can become fibrinous and develop a pleural peel requiring decortication. Management of empyema or parapneumonic depends on the severity and size of the pleural effusion and the local expertise. Both can be managed conservatively with a chest tube and antibiotics; however, higher readmission and reintervention rates were observed in patients managed with chest tubes, suggesting some of these patients may benefit from earlier VATS or thoracotomy (3). The presence of gram-negative organisms or a delayed referral for operative intervention (>2 weeks) both increase the likelihood of having to convert from VATS to thoracotomy in patients undergoing VATS for empyema (4). In this patient, the delay from initial identification of pleural effusion to drainage likely contributed to need for thoracotomy for decortication.
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