“Empyema thoracis, from the Greek, is defined as ‘‘pus in the chest.’’ The most common precursor of empyema is bacterial pneumonia and subsequent parapneumonic effusion. Other causes of empyema include bronchogenic carcinoma, esophageal rupture, blunt or penetrating chest trauma, mediastinitis with pleural extension, infected congenital cysts of the airway and esophagus, extension from sources below the diaphragm, cervical and
thoracic spine infections, as well as postsurgical etiologies.”

“One of the major decision points during any attempted VATS procedure is when to convert to an open thoracotomy. Uncontrollable bleeding, injury to structures not amenable to thoracoscopic repair, and acute intolerance of single-lung ventilation are universal indications for immediate conversion to thoracotomy. With respect to empyema, 2
additional factors that should prompt consideration for conversion are lack of surgical progression and failure to ultimately achieve the 2 goals of empyema therapy
(evacuation and expansion).”

Shen KR, et al The American Association for Thoracic Surgery consensus guidelines for the management of empyema. J Thorac Cardiovasc Surg. 2017 Jun;153(6):e129-e146.