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Pediatric Empyema Follow-up

  • Author: Peter H Michelson, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Dec 03, 2014
 

Further Outpatient Care

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  • Obtain follow-up radiographs and pulmonary function tests to determine prognosis of patients with empyema and to confirm resolution of pleural and parenchymal changes.
  • Consider a follow-up chest CT scan after the radiography findings clear.
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Inpatient & Outpatient Medications

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  • See Medication.
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Transfer

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  • Children should receive their care in hospitals equipped to deal with ill children and staffed with the appropriate pediatric subspecialists.
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Complications

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  • Fibrothorax, a complication reported in the adult literature, is rarely observed in pediatric patients.
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Prognosis

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  • The prognosis for most patients with parapneumonic effusions is quite good.
  • Extended antibiotics may be needed in some patients with complicated parapneumonic effusions (CPE).
  • Despite the variability in presentation, most patients recover without sequelae.
  • Numerous studies have demonstrated resolution of the radiographic abnormalities by 3-6 months following therapy, with few to no symptoms reported at follow-up examination.
  • Pulmonary function testing performed following hospitalization has not shown marked abnormalities, regardless of clinical course. The only abnormality observed may be slight expiratory flow limitation. Mild obstructive abnormalities were the only findings observed in patients evaluated 12 years (±5) following recovery from empyema.
  • Some increased bronchial reactivity has been reported at later follow-up examinations; however, lung function and exercise response return to normal for most patients.
  • Early recognition of pneumonia with parapneumonic effusion, effective intervention to identify the causative organism, and initiation of definitive therapy reduce morbidity and complications associated with this process.
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Patient Education

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Contributor Information and Disclosures
Author

Peter H Michelson, MD Associate Professor of Pediatrics, Division of Pulmonary and Sleep Medicine, Duke University School of Medicine

Peter H Michelson, MD is a member of the following medical societies: International Society for Heart and Lung Transplantation, American Academy of Pediatrics, American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

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Radiographic imaging of a parapneumonic effusion may be useful in assessing the stage of the effusion and the type of drainage needed. In Figure A, the left heart border is obscured, and more than 50% of the left hemithorax is filled with an effusion, as evidenced by a fluid meniscus. In Figure B, the effusion is demonstrated to be fluid because it layers out on a decubitus film. In Figure C, the lateral radiograph again demonstrates the fluid meniscus and filling of the posterior sulcus. These findings suggest tube thoracostomy placement may be sufficient to drain this pleural process.
Most parapneumonic effusions treated with the appropriate antimicrobials of sufficient duration resolve without the development of complications or sequelae. The series of radiographs represent a patient treated with thoracentesis alone. Figure A illustrates the patient at presentation. Note the amount of fluid present. In Figure B, the radiograph demonstrates progression of the pleural fluid accumulation with further airspace disease and scoliosis noted. Despite the radiographic evidence of disease progression, the patient was clinically improving. Figure C illustrates the radiograph at follow-up, 6 months following completion of therapy. Resolution of the parapneumonic effusion with no evidence of pleural thickening or fibrosis occurred.
 
 
 
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