Surgery for thoracic empyema in adults

Surgery may be required for adults in whom thoracic empyema does not resolve despite adequate antibiotic therapy, intrapleural enzyme therapy and drainage (including the placement of additional catheters under imaging into the other loculations if necessary). Consult a thoracic surgeon for consideration of thoracoscopy (including video-assisted thoracoscopic surgery), or thoracotomy and open drainage.

Persistence of chest X-ray abnormalities in an adult who is clinically well is not an indication for surgery; this usually improves over time.