Tracheobronchial Amyloid Subglottic Stenosis Treatment Using Low-temperature Radio frequency Therapy.

Abstract

iodine.7,8 In the modern era, intrapleural antiseptics are not used due to an expanded armamentarium of antibiotics and improved surgical techniques. A small, randomized control trial did demonstrate improved pleural evacuation with normal saline irrigation when used in addition to standard management.9 In this challenging case, it is possible that the inability to fully evacuate his pleural space despite standard medical management contributed to increasing antibiotic resistance. We felt it was imperative to achieve source control to manage his sepsis. As he was not a candidate for surgical evacuation, we opted to use Dakin’s Solution when multiple courses of tPA/ DNase failed. It is unclear whether the empyema would have resolved with escalation of antibiotics alone. His empyema, however, recurred despite 2 rounds of appropriate antibiotics, thoracostomy tube drainage, and intrapleural fibrinolytics.He achieved resolution of his empyema after irrigation with Dakin’s Solution which suggests it may have played a role in his improvement. Notably, he tolerated the procedure well without any serious complications. Intrapleural antiseptics may be considered in patients with medically refractory empyema who are not surgical candidates.