Video-assisted thoracoscopic surgery in the management of acute purulent mediastinitis and pleural empyema.

Management of acute purulent mediastinitis requires broad-spectrum antibiotics and proper surgical drainage-routine use of thoracotomy is recommended by several authors. We describe two cases where video-assisted thoracoscopic surgery (VATS) was used instead of thoracotomy. Etiology of mediastinitis in one patient was a stab wound and in the other an iatrogenic esophageal perforation. In addition, the first patient had purulent pericarditis and suppurated haemothorax and the second a pleural empyema. In both cases VATS allowed debridement of the entire thoracic cavity and subsequent drainage of the mediastinum. Continuous irrigation was used postoperatively until pleural fluid became clear. Both patients recovered without a need for further surgical treatment. They are doing well 8 and 9 months later. Adequate debridement and drainage of pleural empyema and mediastinitis can be achieved using VATS instead of a thoracotomy approach.