FROM FIBRIN TO FIBROSIS: CASE SERIES OF VATS IN EMPYEMA THORACIS japsimranjitkhalae@gmail.com

 

FROM FIBRIN TO FIBROSIS: CASE SERIES OF VATS IN EMPYEMA THORACIS

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Malaysia

Oral or Poster

Trauma-related pleural complications such as retained haemothorax, loculated pleural collections, and lung entrapment pose significant management challenges. Early application of Video-Assisted Thoracoscopic Surgery (VATS) has emerged as a minimally invasive alternative to open thoracotomy, allowing both diagnosis and treatment. This case series highlights the use of VATS in four patients presenting at different stages of post-traumatic pleural pathology.

A retrospective review of four male patients aged 38–53 years with chest trauma due to road traffic accidents or falls, admitted between February and April 2025. All underwent CT imaging, chest tube insertion, and VATS. Clinical findings, imaging, intraoperative features, and outcomes were analyzed and staged according to empyema progression.

Case 1 (Stage III – Organizing): VATS on PTD 12 revealed multiloculated pleural effusion with trapped lung and thick slough. Adhesiolysis enabled lung re-expansion. ICU stay: 10 days; hospital stay: 39 days. Case 2 (Stage II – Fibrinopurulent): VATS on PTD 7 revealed fibrinous deposits and clots. Post-washout lung expansion was good. No ICU stay; hospital: 10 days. Case 3 (Stage III – Organizing): VATS on PTD 13 showed multiloculated effusions and incomplete lung collapse. Washout and lung re-expansion were successful. ICU: 30 days; hospital: 40 days. Case 4 (Stage I – Exudative): Early VATS on PTD 1 in a penetrating chest wound revealed serous effusion, muscle tears, and no parenchymal injury. ICU: 1 day; hospital: 11 days.

VATS is effective across all stages of post-traumatic empyema thoracis. Early-stage intervention leads to shorter hospitalization and better recovery by timely surgical patient assessment.