"Hope Chest": A Review of the Imaging Findings of the “Eloesser Flap” Thoracostomy Window and Clagett Thoracotomy

Purpose: -Review the radiologic findings in thoracic appearance associated with the creation of the Eloesser flap thoracostomy window and Clagett open thoracotomy window.
-We discuss the choice of imaging studies to ensure optimal management of chronic empyema in these patients.

Methods/Materials: Radiologic imaging plays a routine but essential role in the perioperative management of Eloesser Flap thoracostomy and Clagett thoracotomy. Eloesser flap thoracostomy is a lifesaving operative treatment of refractory pleural empyema in debilitated patients unable to tolerate decortication, allowing for a permanent one-way valve for drainage of the pleural space infection. Clagett thoracotomy is a 3 stage procedure and offers an open thoracotomy window that differs in that the Clagett window is larger and reversible. Both surgical options involve extensive postoperative pleural drainage and care. Chest radiographs and computed tomographs (CT) are essential in the postoperative monitoring. Our objective is to review the radiographic changes with Eloesser flap and Clagett window evaluation of complications.

Results: We discuss the findings on various radiographic studies of the differences between the Eloesser flap and Clagett window. It is important to have a strong understanding of these procedures to appropriately interpret findings on imaging studies. In both procedures, the primary goal is to promote drainage and resolution of the empyema while preventing re-accumulation of infected fluid. Imaging helps guide the surgical intervention and identify any complications that may arise, such as recurrent empyema or problems with flap placement.

Conclusions: Even with medical advancement in treatment of empyema, Eloesser flap thoracostomy and Clagett open thoracotomy continue to play a lifesaving role in treating refractory empyema. Radiologist’s understanding of the radiologic changes in thoracic appearances and post-operative complications is important in the post-surgical management of these patients.