Parapneumonic Effusion and Empyema
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Parapneumonic effusion (PPE) is a collection of fluid in the pleural space secondary to pneumonia, which in children is most often community acquired pneumonia (CAP). A complicated PPE is one for which an invasive procedure, such as a tube thoracostomy, is necessary for treatment or in which thoracentesis indicates an evolution to empyema. An empyema is a collection of pus in the pleural space, usually as a result of bacterial infection of a PPE, and requires hospitalization and surgical intervention.
The diagnostic work up and decision to perform surgery versus image guided drainage and/or pharmacological fibrinolysis requires careful consideration. Most children with empyema can be successfully treated by following an algorithm that emphasizes early diagnosis of loculated fluid collections suggestive of a complicated PPE followed by a minimally invasive approach utilizing image guided catheter directed fibrinolysis, tube thoracostomy with fibrinolysis or video assisted thoracoscopic surgery (VATS).
There are few Level A evidence based studies that are available to guide the prevention, diagnosis and management of PPE and empyema . Opportunities exist to perform larger multi-institutional studies that will provide more robust evidence to answer these questions and to enable us to treat these conditions in an evidence based, economically sound manner .
see also Parapneumonic Effusion Procedures
Content in this topic is referenced in SCORE Empyema