Abstract
A 53-year-old man was refered to our hospital under the diagnosis of lung cancer. Right pneumonectomy was performed after a preoperative induction chemoradiotherapy. The pathological TNM stage was pT2N0M0. After a postoperative adjuvant chemotherapy including cisplatin, he was admitted to our hospital because of a high fever with severe neutrocytopenia. He was diagnosed as postpneumonectomy empyema without bronchopleural fistula which occurred under neutrocytopenia after chemotherapy. The culture of pleural effusion revealed empyema caused by penicillin-resistant Streptococcus pneumoniae. Chest tube drainage and irrigation were performed immediately. Antibiotics sensitive to the penicillin-resistant Streptococcus pneumoniae and G-CSF were administered. The general condition of the patient gradually improved. Thoracoscopic debridement of the empyema space was performed without insertion of drainage tube. A muscle flap closure of the pneumonectomy space was not performed. He is currently doing well after a four-month follow-up. Care must be taken concerning neutrocytopenia-associated complications when patients have undergone postoperative adjuvant chemotherapy. Thoracoscopic debridement might be a valuable approach for patients with postpneumonectomy empyema without a bronchopleural fistula.
