Abstract
A 60-year-old man with right chest pain, dyspnea and general fatigue presented to our hospital. Chest X-ray examination showed that pleural fluid with niveau filled the right thoracic cavity. We diagnosed the case as right pyopeumothorax, and promptly started continuous suction drainage of the right thoracic cavity and administration of antibiotics. However, dirty drainage and inflammation persisted, and we added one more chest tube for continuous irrigation. The inflammation immediately subsided, but the size of the abscess cavity was not reduced by irrigation and drainage. We thus performed right open window thoracostomy to curette and abundantly wash the abscess cavity. On the postoperative day 2, the vacuum assisted closure (VAC) therapy with insertion of dressing foam into the abscess cavity was begun. The VAC therapy was continued for a month, and the abscess cavity and wound were completely closed in approximately a month after the end of the VAC therapy. The early introduction of the VAC therapy after open window thoracostomy for refractory pleural empyema may be an effective tool for accelerating reduction of abscess cavity and wound healing.
