[Scintigraphic assessment of ventilation and perfusion after late decortication of the lung due to chronic empyema].

OBJECTIVE

The purpose of this work was to assess ventilation and perfusion and to determine the ventilation/perfusion ratio in patients managed with decortication due to chronic pleural empyema.

METHODS

The study group comprised 28 patients, including 22 with left-side and 6 with right-side decortication. The period from onset of disease to surgery ranged from 23 to 290 days. Postoperative follow-up ranged from 9 to 183 months. All patients underwent basic laboratory tests, spirometric measurements, gasometry of arterialised blood at rest and a chest X-ray examination. Lung ventilation was examined with the isotope method using 99m-Tc (Technetium) labeled albumin microspheres. Lung perfusion was examined using 99m-Tc (Technetium) labeled macroaggregates of human albumin given intravenously. Perfusion and ventilation were assessed and the ratio of ventilation to perfusion on the operated and contralateral sides was calculated. Spirometry values (FVC, FEVI, FEVI%FVC) were within normal.

RESULTS

The results show a reduction in ventilation and perfusion on the decorticated side and compensatory increase on the opposite side. Concurrently, a reduction in the ventilation/perfusion ratio on the operated side was found. Decortication of the chronic pleural empyema is supposed to improve ventilation on the operated side. Functional results of surgery have so far been assessed in the literature basing solely on the spirometric test. The present findings suggest that contrary to expectations after this type of surgery, perfusion and ventilation remain considerably impaired on the operated side.