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. 2023 Jun 14;13(1):9658.
doi: 10.1038/s41598-023-36420-w.

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging

Xiaoyu Liu #  1 , Xuan Wang #  1 , Jian Sheng  1 , Yuhui Jiang  1 , Li Li  2 , Xiyong Dai  3
Affiliations

Open decortication for patients presenting with stage III tuberculous empyema with low density lines on CT imaging

Xiaoyu Liu et al. Sci Rep. .

Abstract

To explore the influence of CT findings on the optimal timing of open decorticationin patients with stage III tuberculous empyema. A total of 80 patients with stage III tuberculous empyema who had undergone open decortications were recruited; 44 patients had chest CT findings indicating low-density lines, while 36 patients did not show this imaging finding. Demographic data, perioperative data and preoperative and postoperative chest CT images were collected. In the low-density line group, the duration of disease (P = 0.0030) and the preoperative anti-tuberculosis time (P = 0.0016) were longer than those of the group without low-density lines, and the ESR (P = 0.0218), CRP (P = 0.0027) and leukocyte count (P = 0.0339) were lower in the low-density line group. Additionally, in the median operative time (P = 0.0003), intraoperative blood loss (P < 0.0001), volume of catheter drainage during 48 h after operation (P = 0.0067), chest tube duration (P < 0.0001), and length of hospital stay (P = 0.0154) were significantly lower in the low-density line group than in the group without low-density lines. A total of 88.64% of participants in the low-density line group showed hyperplasia with hyaline degeneration in pathological examination, which was observed only in 41.67% of patients without low-density lines. In addition, gaseous necrosis was considerably higher in patients without a low-density line (P = 0.004), while the low-density line group had a higher rate of treatment success (P < 0.05). Patients with stage III tuberculous empyema presenting with low-density lines around the thickened fibrous pleural rind on preoperative CT imaging may be good candidates for open decortication.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
CT and pathological pictures of patients with or without low-density lines (A). There was no obvious boundary between the fibrous pleural rind and the parietal pleura (B). The typical pathological change in patients without a low-density line was caseous necrosis (C). The distinct “low-density line between the fibrous pleural rind and the parietal pleura” (D) The typical pathological change in patients with a low-density line was hyperplasia with hyaline degeneration.
Figure 2
Figure 2
Recovery of the thorax after surgery. Preoperative CT (A) showed left empyema, fibrous plate formation, and no obvious low-density line. The operation time was 6 h, the intraoperative bleeding volume was 800 mL, the postoperative exudation volume was 910 mL, and the duration of drainage was 29 days. (B,C) Are 2 months and 4 months after the operation, respectively. Preoperative CT (D) showed right empyema, fibrous plate formation, and a low-density line. The operation lasted 4.5 h, the intraoperative bleeding volume was 300 mL, the postoperative exudation volume was 580 mL, and the duration of drainage was 7 days. (E,F) were 2 months and 4 months after the operation, respectively.
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