Clinical Analysis of Eight Cases of Acute Nontuberculous Pleural Empyema

Eight adults were admitted to the Seiranso Byoin National Sanatorium with the diagnosis of acute nontuberculous pleural empyema during a three year period (Sept., 1985∼Sept., 1988). Six of the patients were men, and two were women. Their ages ranged from 32 to 64 years; six of them were older than 50. These eight patients had no history of tuberculosis. Their common presenting symptoms were high fever (39°C) and chest or back pain. Their chest films showed air-fluid collection, with different air-fluid levels on frontal, lateral, and decubitus projections. The right pleural space was more affected than the left. All eight patients underwent closed chest tube thoracostomy and systemic chemotherapy immediately after pleural empyema was diagnosed. When the chest x-ray showed different air-fluid levels on a single projection, the empyema cavity was composed of multiple pockets within the pleural space. Even when the empyema cavity appeared to be a single round space, it was, in some cases, composed of discrete pockets which were noted to interconnect on computed tomography of the chest. Chest computed tomography was helpful for proper chest tube placement and consequent successful empyema drainage. Pleural fluid cultures grew anaerobic bacteria (Peptostreptococcus) in two cases and aerobic bacteria in three (Streptococcus pneumoniae in one patient and an α-Streptococcus other than Streptococcus pneumoniae in two patients). Six patients of the eight have diabetes mellitus. Two of these six were known diabetics before admission but not treated. Four were diagnosed as having diabetes during this admission. Diabetes mellitus is thus strongly considered a predisposing factor for pleural empyema.