Clinical Challenges in Thoracic Surgery: Complex Pleural Effusions & Empyema - Part 1 of 2

This episode of Behind the Knife addresses the clinical challenge of managing complex pleural effusions and empyema, specifically whether to pursue surgical decortication or non-operative management with lytic therapy. The discussion centers on a case of a 39-year-old male with a worsening pleural effusion, complicated by a high white count and compressive atelectasis. Interventional pulmonologist Dr. Jed Gorden joins the hosts to discuss the MIST-2 trial, which demonstrated the benefits of intrapleural tPA plus DNase. The speakers explore the nuances of chest tube size, patient comfort, and the latest randomized control trial data, weighing the pros and cons of surgical intervention versus lytic therapy. The episode concludes with a review of how to frame these options for patients, emphasizing shared decision-making.