Successful closure of open window thoracostomy using omental flap without total dead-space obliteration: A case of empyema with pleural plaques

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  • Sueyoshi Kuniyo
    Department of Thoracic Surgery, Medical Hospital, Tokyo Medical and Dental University
  • Ishibashi Hironori
    Department of Thoracic Surgery, Medical Hospital, Tokyo Medical and Dental University
  • Mori Erika
    Department of Thoracic Surgery, Medical Hospital, Tokyo Medical and Dental University
  • Nakashima Yasuhiro
    Department of Thoracic Surgery, Medical Hospital, Tokyo Medical and Dental University
  • Kobayashi Masashi
    Department of Thoracic Surgery, Medical Hospital, Tokyo Medical and Dental University
  • Okubo Kenichi
    Department of Thoracic Surgery, Medical Hospital, Tokyo Medical and Dental University

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  • 広範囲胸膜プラークを伴った難治性膿胸に対して死腔を残し大網充填閉窓した1例

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Abstract

<p>An 84-year-old male, who underwent thoracoscopic biopsy of the pleura due to pleural effusion and pleural callosity of the right chest and was consequently diagnosed with pleural plaques, developed pleural empyema after the biopsy. The empyema was refractory to thoracoscopic pleural curettage; therefore, open window thoracostomy was performed. After a total of 5 curettements of the calcified pleural plaques and the management of comorbidities such as diabetes and congestive heart failure, the thoracostomy was successfully closed with a pedicled omental flap transposition while a large cavity remained unfilled. The principle of a successful thoracostomy closure is considered to be achieving asepsis in the thoracic cavity and subsequent filling of the cavity by completely closing the dead space. We will discuss the possible reasons why the empyema was cured without the complete obliteration of the dead space in the present case.</p>

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