Open window thoracostomy, myoplasty, and epiploplasty for treatment of postpneumonectomy empyema: CT evaluation.

Abstract

To demonstrate the computed tomographic (CT) appearance of the postpneumonectomy space (PPS) after surgical treatment of postpneumonectomy empyema. The authors retrospectively reviewed 22 CT scans obtained in 15 patients after open window thoracostomy (OWT) (n = 4), myoplasty (n = 12), and epiploplasty (n = 1). After uncomplicated OWT, the retracted PPS contained air and/or gauze without residual pleural fluid. After uncomplicated myoplasty, marked retraction of the operated hemithorax was observed. CT allowed localization of transposed muscle flaps and fatty tissue within the PPS. A moderate amount of fluid and air was present during the 1st month after surgery. After uncomplicated epiploplasty, the retracted PPS contained homogeneous tissue with characteristic fatty attenuation. Complications including recurrent empyema, recurrent bronchopleural fistula, aseptic fluid collection, necrosis and fatty transformation of muscle flaps, and tumor recurrence were accurately demonstrated. CT is useful in follow-up after surgical treatment of postpneumonectomy empyema because it permits accurate evaluation of the PPS.