Fifteen-minute consultation: A structured approach to children with parapneumonic effusion and empyema thoracis

2021 ◽  
pp. edpract-2021-322621
Author(s):  
Joanna Kirstin B Dykes ◽  
Adam Lawton ◽  
Saskia Burchett ◽  
Atul Gupta
Keyword(s):  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Parapneumonic Effusion ◽  
Empyema Thoracis ◽  
Children And Young People ◽  
Intravenous Antibiotics ◽  
Lung Expansion ◽  
Infection And Inflammation ◽  
Spread Of Infection ◽  
Structured Approach

Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis—frank pus in the pleural space. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.

scholarly journals Assessment of bacteriological profile and outcome of empyema thoracis in hospitalized children in a tertiary care hospital of Raipur city, Chhattisgarh, India

2018 ◽  
Vol 5 (5) ◽  
pp. 1914
Author(s):  
Aradhana Toppo ◽  
Shruti Yadu
Keyword(s):  
Antibiotic Therapy ◽  
Economic Status ◽  
Tertiary Care ◽  
Pleural Space ◽  
Care Hospital ◽  
Empyema Thoracis ◽  
Medical College ◽  
Lung Expansion ◽  
Streptococcal Species ◽  
The Right

Background: An empyema is a purulent collection in the pleural space. Empyema Thoracis is a disease that, despite centuries of study, still causes significant morbidity & mortality. It is very commonly seen in children all over the world, more frequently as a complication of pneumonic infections. Pediatric empyema has a much more favorable prognosis compared to adult cases. Empyema thoracic is a common complication of pneumonia. Children of poor socio-economic status and below 3 years of age are most commonly affected.  Methods: The present prospective observational study was conducted in Department of Surgery, Pediatric Surgery unit, Pt. J. N. M. Medical College and Dr. B. R. A. M. Hospital, Raipur (C.G.) during study period July 2011 to October 2012. This study includes 40 study subjects of the patients of empyema who were diagnosed by the aspiration of gross pus from the pleural space. Complete History was taken, and physical examination was performed in all the cases.Results: The commonest symptoms at presentation were fever seen in 40 patients (100%), cough with expectoration seen in 36 patients (50%-90%) and dyspnea seen in 32 patients (80%). Left pleura was more commonly affected than the right pleura. The most common organism isolated were Staphylococcus aureus in 28 patients (70%), followed by Klebsiella in 7 patients (17.50%), then E.coli in 3 patients (7.5%) & Streptococcal species in 2 patients (5%). The use of antibiotic therapy alone was effective in 25 patients (62.50%) Antibiotic therapy along with tube thoracostomy was required in 15 patients (37.50%). Operative intervention was required in none of the patients. Out of 40 patients, 28 (70%) had complete lung expansion, while 12 (30%) had only partial expansion. Patients with partial expansion mainly comprised of those who presented late in the course of the disease.Conclusions: It is concluded from the study that early diagnosis and management is critically important in reducing the unfavourable outcome in pediatric espuma thoracis cases.

Legionella pulmonary abscess and pleural space infection in an immunocompetent patient

2021 ◽  
Vol 14 (5) ◽  
pp. e243026
Author(s):  
Kristen L Flint ◽  
Maxwell R Lloyd ◽  
Polly van den Berg ◽  
Zahir Kanjee
Keyword(s):  
Antibiotic Therapy ◽  
Immunocompetent Patient ◽  
Fibrinolytic Therapy ◽  
Pleural Space ◽  
Ct Imaging ◽  
Flank Pain ◽  
Parapneumonic Effusion ◽  
Space Infection ◽  
Pulmonary Abscess ◽  
Complicated Parapneumonic Effusion

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her Legionella urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. CT imaging revealed interval development of a loculated complicated parapneumonic effusion. Successful treatment required chest tube drainage assisted by fibrinolytic therapy. This case highlights the importance of considering Legionella in patients with pulmonary abscess, demonstrates an approach to a patient with a non-resolving pneumonia and illustrates the management of parapneumonic effusions.

scholarly journals Pediatric empyema thoracis: our surgical experience

2021 ◽  
Author(s):  
Manisha Albal ◽  
Prasad Y. Bansod ◽  
Deep Mashru
Keyword(s):  
Thoracoscopic Surgery ◽  
Tertiary Care ◽  
Ground Level ◽  
Fibrinolytic Therapy ◽  
Treatment Modalities ◽  
Empyema Thoracis ◽  
Surgical Interventions ◽  
Tube Drainage ◽  
Lung Expansion

Incidence of empyema is increasing despite various treatment modalities available. Management of pediatric empyema remains a challenge due to factors like malnutrition, poverty, TB, delay in early intervention and incomplete treatment course. It is necessary to address these issues at ground level. A short 2-year prospective study was carried out at a tertiary care teaching hospital where 17 consecutive cases of pediatric empyema were managed.  Among 17 cases, all patients intercostal tube drainage (ICD) was required. Six patients underwent surgical interventions [2 video-assisted thoracoscopic surgery (VATS) and 4 open thoracotomies] while 11 were managed on ICD and antibiotics. Fibrinolytic therapy was not administered in any case. Follow-up showed good lung expansion with apparent rib crowding in 3 cases and no mortality. Majority of empyema in children are post pneumonic. Chest tube drainage, antibiotics along with intrapleural fibrinolytic is a safe and effective method of treating empyema thoracis in children in resource- poor settings and can reduce the need for invasive interventions.

Role of Fibrinolytic Therapy in Empyema Thoracis – A Hospital Based one year Cross Sectional Study

2012 ◽  
Vol 2 (2) ◽  
pp. 345-350
Author(s):  
Dr. Girish.L Dandagi ◽  
◽  
Venkat kalyana kumar. P ◽  
Dr. Dr.Isaac Mathew ◽  
Dr. Dr.G S Gaude Dr. Dr.G S Gaude
Keyword(s):  
Cross Sectional Study ◽  
Fibrinolytic Therapy ◽  
Empyema Thoracis ◽  
Sectional Study ◽  
Cross Sectional ◽  
One Year

Suppurative diseases of the lung and pleural space part I: Empyema thoracis and lung abscess

1986 ◽  
Vol 23 (1) ◽  
pp. 5-89 ◽  
Author(s):  
B.T. le Roux ◽  
M.L. Mohlala ◽  
J.A. Odell ◽  
I.D. Whitton
Keyword(s):  
Lung Abscess ◽  
Pleural Space ◽  
Empyema Thoracis

Parapneumonic Effusion and Pleural Space Infections

2012 ◽  
pp. 1662-1666
Author(s):  
Cedric W. Lefebvre ◽  
Jay P. Babich ◽  
James H. Grendell ◽  
James H. Grendell ◽  
John E. Heffner ◽  
...  
Keyword(s):  
Pleural Space ◽  
Parapneumonic Effusion

Pleural stress pressure as a force to control liquid accumulation and maintain lung expansion

1985 ◽  
Vol 58 (2) ◽  
pp. 339-345 ◽  
Author(s):  
K. Harada ◽  
T. Mutsuda ◽  
N. Saoyama ◽  
N. Hamaguchi ◽  
Y. Shimada
Keyword(s):  
Chest Wall ◽  
Mean Value ◽  
Pleural Space ◽  
Liquid Volume ◽  
Parietal Pleura ◽  
Elastic Recoil ◽  
Normal Range ◽  
Pleural Surface ◽  
Lung Expansion ◽  
The Relationship

Total gas pressure in the pleural space is more subatmospheric than that in the alveolar cavity. This pressure difference minus elastic recoil pressure of the lung was termed stress pressure. We investigated the relationship between stress pressure and a force that would hold the lung against the chest wall to prevent accumulation of liquid. The condition was a pleural space with an enlarged pleural surface pressure. Dogs anesthetized with pentobarbital sodium were placed in a box maintained subatmospherically at approximately -30 cmH2O and breathed atmospheric air for 4 h. Liquid volume in the pleural space of the dogs was measured under conditions of thoracotomy. In the normal group, the volume of the pleural liquid was within the normal range of approximately 2.0 ml and the visceral and the parietal pleura made contact. In the pneumothorax group, established by injecting 50 ml of air into the pleural space, the liquid increased significantly in all cases by a mean value of approximately 12 ml. Thus pleural stress pressure seems to be an important force holding the lung against the chest wall and aiding in the control of accumulation of liquid in a more subatmospheric pleural space.

scholarly journals Operative management of pediatric empyema: a single center review

2018 ◽  
Vol 21 (1) ◽  
pp. 10-13
Author(s):  
Aakriti Sharma ◽  
Ranjan Sapkota ◽  
Bibhusal Thapa ◽  
Prakash Sayami
Keyword(s):  
Thoracoscopic Surgery ◽  
Treatment Options ◽  
Operative Management ◽  
Successful Outcome ◽  
Open Approach ◽  
Empyema Thoracis ◽  
Transplant Center ◽  
Lung Expansion ◽  
Recorded Data ◽  
Video Assisted Thoracoscopic Surgery

Introduction: Empyema thoracis is an uncommon complication of childhood pneumonias but a common problem faced by a thoracic surgeon. Its management is still controversial, with a range of treatment options available and evolving gradually towards adoption of video-assisted thoracoscopic surgery (VATS) as the most commonly practiced one. Aim: The aim of this study was to review our experience in pediatric empyema thoracis. Methods: It was a retrospective review of the prospectively recorded data, spanning a period of 18 months in the Department of Cardio-Thoracic and Vascular Surgery in Manmohan Cardio-Thoracic Vascular and Transplant Center. Results: A total of 40 consecutive patients, 29 males and 11 females, aged 15 years or less were operated upon for a diagnosis of empyema thoracis made based on clinical, radiological and laboratory evidence. All of them were referred patients, mostly from pediatricians. VATS was undertaken in 36 of them, the remaining four treated by open approach. Deloculation sufficed in majority (26/40; 65%) of the patients which mostly (23/26; 90%) had either acute or subacute presentation. Decortication was required in 35% (14/40) of the patients. However, all of the patients but one had a successful outcome in terms of lung expansion, sterilization of the pleural cavity and absence of recurrence. There was no operative mortality. Conclusion: Surgical management of pediatric thoracic empyema is feasible and safe with favorable outcome. VATS is gradually becoming the more favored modality of operative management.  

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