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Parapneumonic Effusion and Empyema

Parapneumonic Effusion and Empyema is a topic covered in the Pediatric Surgery NaT.

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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 [1][2][3]. 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 [1][2][3][4].

see also Parapneumonic Effusion Procedures

Content in this topic is referenced in SCORE Empyema

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Last updated: August 1, 2018


Grewal, Harsh, and Anna Shawyer. "Parapneumonic Effusion and Empyema." Pediatric Surgery NaT, American Pediatric Surgical Association, 2018. APSA Webapp, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829079/all/Parapneumonic_Effusion_and_Empyema.
Grewal H, Shawyer A. Parapneumonic Effusion and Empyema. In: Waldhausen J, Powell D, Hirschl R, eds. Pediatric Surgery NaT. American Pediatric Surgical Association; 2018. https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829079/all/Parapneumonic_Effusion_and_Empyema. Accessed June 25, 2019.
Grewal, H., & Shawyer, A. (2018). Parapneumonic Effusion and Empyema. In Waldhausen, J., Powell, D., & Hirschl, R. (Eds.), Pediatric Surgery NaT. Available from https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829079/all/Parapneumonic_Effusion_and_Empyema
Grewal H, Shawyer A. Parapneumonic Effusion and Empyema [Internet]. In: Waldhausen J, Powell D, Hirschl R, editors. Pediatric Surgery NaT. American Pediatric Surgical Association; 2018. [cited 2019 June 25]. Available from: https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829079/all/Parapneumonic_Effusion_and_Empyema.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Parapneumonic Effusion and Empyema ID - 829079 A1 - Grewal,Harsh,MD AU - Shawyer,Anna,MD ED - Waldhausen,John, ED - Powell,David, ED - Hirschl,Ron, Y1 - 2018/08/01/ BT - Pediatric Surgery NaT UR - https://www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829079/all/Parapneumonic_Effusion_and_Empyema PB - American Pediatric Surgical Association DB - APSA Webapp DP - Unbound Medicine ER -