The management of empyema varies according to etiology and chronicity. Empyema most commonly arises in
the setting of pneumonia. In general, early surgical drainage, using thoracoscopic approaches, are favored as they appear
to be associated with quicker resolution and lower complication rates. However, anatomic and physiologic issues may
affect outcomes and approaches, notably the presence or absence of thick visceral peel and/or other causes of a persistent
space. In these settings, combined catheter based, medical and more aggressive surgical approaches may be required.
Keywords: Decortication, empyema, lytic therapy, parapneumonic, thoracoscopy, etiology, chronicity, visceral peel, fibrinolytic agents, pulmonary interstitial fluid.
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