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NIGER DELTA JOURNAL OF MEDICINE & MEDICAL RESEARCH

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Archive | ISSUE: , Volume: Jan-Mar-2026

EMPYEMA THORACIS: UPDATE REVIEW CORRELATING ITS CLASSIFICATIONS TO MEDICAL AND SURGICAL MANAGEMENT


Author:Bello US

published date:2026-Mar-29

FULL TEXT in - | page 11–24

Abstract

Background: Empyema thoracis (ET) is a pleural infectious disease with geographical variations. Its sequela is chronicity, which imposes a significant health burden due to prolonged chest tube drainage and a series of surgical procedures. The estimated cost per admission in Europe is approximately €21,822, while the cost of failed image-guided catheter drainage is $55,609.32. Surgical drainage is required in about a quarter of patients with failed standard treatment. The incidence of ET is rising, along with hospital mortality. Numerous guidelines are emerging; however, many controversies in management remain. Polymicrobial pathogens and multiple risk factors make ET a complex clinical entity. Prognostic risk factors can predict morbidity outcomes, but clinical scoring systems for empyema thoracis may allow earlier detection and treatment, thereby reducing chronic morbidity.

Methodology: Literature searches using keywords were conducted in Google Scholar, PubMed, African Journals Online, Scopus, Cochrane, and Embase for original articles, reviews, case reports, and guidelines.

Results: Empyema stages I and III have less controversial treatment options. The largest randomised controlled trial, the MIST2 Trial, reported a 75% reduction in the need for surgical intervention within three months, with clinical improvement in pleural drainage from the combined use of DNase and intrapleural tissue plasminogen activator. Several guidelines have endorsed the prognosticrisk factors identified in the MIST2 trial. However, a Clinical Scoring for Empyema Thoracis Management (CSETM) is proposed to facilitate early detection.

Conclusion: More research is needed on ET. The proposed CSETM is more inclusive than the prognostic risk index alone, comprising 15 variables in a checklist format that can be completed in approximately five minutes. This tool may be particularly useful for rural doctors in resource-limited settings, aiming at early and accurate diagnosis and treatment to reduce the morbidity associated with chronic ET.

 

Cite this article: Bello US. Empyema thoracis: Update review correlating its classifications to medical and surgical management. Niger Delta J Med Med Res. 2026;5(1):11–24.

Keywords: Review, Empyema thoracis, Chest tube, Thoracic, Classification

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