PREOPERATIVE DIAGNOSIS: Right empyema.
POSTOPERATIVE DIAGNOSIS: Right empyema.
PROCEDURE PERFORMED: Right chest tube thoracostomy with drainage of 1100 mL of purulent fluid.
SURGEON: John Doe, MD
ANESTHESIA: IV sedation with local.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old Hispanic male with past medical history significant for schizophrenia as well as diabetes, who presented from a nursing home complaining of ongoing issues of shortness of breath and fevers. The patient underwent further workup, including x-ray, and was noted to have a large right-sided pleural effusion and underwent thoracentesis and removed large amount of purulent exudate from the chest cavity.
CT scanning confirmed that there was an empyema and evidence of significant pleural thickening and effusions. We did discuss with the patient at length about undergoing decortication on this side because we felt it was the only way to adequately drain this infection, and he unfortunately is adamantly refusing decortication and only would allow us to place a chest tube, so due to the fact that he is adamantly refusing the decortication, we will proceed with right-sided chest tube placement today.
DESCRIPTION OF PROCEDURE: The patient was identified and placed on the operating room table in the supine position. IV sedation with local was induced. The patient’s right chest was prepped and draped in the normal sterile fashion. The patient was given IV antibiotics prior to start of the case.
We made a small incision in the fifth interspace and dissected down to the level of the fifth interspace and injected with 0.25% Marcaine. We then entered the right chest and evacuated 1100 to 1200 mL of milky purulent fluid from the chest cavity. Using Yankauer sucker, we could palpate the area. We could feel the lung was re-expanding once the fluid was drained out. We sent some for cytology as well as for culture and sensitivity.
Once we had drained all the fluid out, we then irrigated and suctioned and then we placed a 36-French chest tube posteriorly within the right chest. We then sutured this in place. Once this was completed, we then closed the wound in three layers and used skin staples on the skin due to the purulence. We sutured the chest tube inside as well with 0 Vicryl.
Once the patient gets to the recovery room, we will check an x-ray. The patient tolerated the procedure well and did not have any issues throughout the entire procedure.
