Pulmonary Resection in the Presence of Localized Empyema

The purpose of this paper is to present in summary three cases of subtotal pulmonary lobectomy and one case of total pneumonectomy, all of which were carried out in the presence of a complicating encapsulated empyema without preliminary drainage. It has been rather commonly considered in cases of pleural empyema complicating suppurative disease of the lung parenchyma that preliminary drainage should precede the surgical extirpation of the primary or originating lesion. In the case of bronchiogenic carcinoma complicated by empyema, it has been held by most observers that the lesion is beyond the hope of any success by surgical intervention. In fact, one author of wide experience in the field of lung cancer has stated that diffuse and dense inflammatory adhesions of the pleura may render a case inoperable even in the absence of frankly purulent accumulations. In a series of forty-two lobectomies and eleven total pneumonectomies, the author has had occasion to treat by primary lobectomy and drainage three cases of middle lobe abscess with perforation and encapsulated interlobar or parietal empyema. In addition, one case of bronchiogenic carcinoma which was complicated by an encapsulated pneumococcal parietal empyema has been treated by total pneumonectomy without drainage. The results in these cases have been sufficiently good to warrant their detailed presentation for discussion as a group.