Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Pleural Effusion Clinical Presentation

  • Author: Dagnachew (Dagne) Assefa, MD, FAAP, FCCP; Chief Editor: Michael R Bye, MD  more...
 
Updated: Nov 10, 2015
 

History

The clinical picture and presenting symptoms of pleural effusion depend on the underlying disease and the size and location of the effusion.

Symptoms linked to the underlying disease

Children with effusion as a complication of pneumonia (parapneumonic effusion or empyema) often have a history of recent upper respiratory tract infection, bronchitis, or pneumonia. These children usually present with the following symptoms:

  • Persistent fever
  • Cough
  • Anorexia
  • Malaise
  • Tachypnea
  • Dyspnea
  • Chest pain

Children with tuberculous pleural effusions may present with the following symptoms[44] :

  • Cough
  • Pleuritic chest pain
  • Dyspnea
  • Night sweats
  • Fever
  • Hemoptysis
  • Weight loss

Malignant effusions may be more indolent and cause either no symptoms or only cough and low-grade fever.[5] Pleural effusion due to a malignant lymphoma may present with respiratory distress, because of the size of the effusion, the mediastinal mass, or both.[45]

In transudative effusions (congestive heart failure, nephrotic syndrome), the underlying disease usually determines the presenting symptoms. Occasionally the child may be asymptomatic until the accumulation becomes large enough to cause symptoms.[35]

Although effusion occurs in association with systemic lupus erythematosus and other autoimmune diseases, it is rarely the initial manifestation.

Symptoms related to the size and location of the pleural effusion

An accumulation of a small amount of fluid may be asymptomatic. A large collection of fluid leads to dyspnea, respiratory distress, dull pain, and coughing. These symptoms may vary with an alteration in body position.

Subpulmonic fluid collection can be associated with vomiting, abdominal pain, and abdominal distention caused by partial paralytic ileus.

Chest pain

Chest pain is pleuritic in origin. Patients with an exudative effusion are more likely to have pain than are patients with a transudative effusion. The pain can be localized or referred to the shoulder and abdomen. It is typically described as sharp or stabbing and worsens with inspiration. The pain intensity lessens as the effusion increases in size; as the effusion increases, it separates the pleural membranes, and the pain becomes dull or disappears.

Next

Physical Examination

The patient may look dyspneic and anxious because of pain, discomfort, or hypoxemia. A pleural rub may be the only initial manifestation during the early stage of pleurisy. The rub disappears as fluid accumulates between the pleural surfaces.

A large fluid collection causes fullness of the intercostal spaces and diminished chest excursion on the affected side. Excessive unilateral fluid accumulation shifts the mediastinum and displaces the trachea and cardiac apex to the contralateral side.

Dullness to percussion, decreased air entry, decreased tactile and vocal fremitus, and voice egophony over the effusion may be present but difficult to detect in younger children.

Previous
 
 
Contributor Information and Disclosures
Author

Dagnachew (Dagne) Assefa, MD, FAAP, FCCP Pediatric Pulmonologist, Pediatric Lung Care, Bon Secours

Dagnachew (Dagne) Assefa, MD, FAAP, FCCP is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, American College of Chest Physicians, American Thoracic Society, European Respiratory Society

Disclosure: Nothing to disclose.

Coauthor(s)

Arthur B Atlas, MD Assistant Clinical Professor, Department of Pediatrics, University of Medicine and Dentistry of New Jersey

Arthur B Atlas, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, American College of Chest Physicians, American Lung Association, American Thoracic Society, Medical Society of New Jersey

Disclosure: Received grant/research funds from astra zeneca for none.

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.

Acknowledgements

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Girish D Sharma, MD Associate Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

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.

References
  1. Wang NS. Anatomy of the pleura. Clin Chest Med. 1998 Jun. 19(2):229-40. [Medline].

  2. Agostoni E, Zocchi L. Mechanical coupling and liquid exchanges in the pleural space. Clin Chest Med. 1998 Jun. 19(2):241-60. [Medline].

  3. Alkrinawi S, Chernick V. Pleural infection in children. Semin Respir Infect. 1996 Sep. 11(3):148-54. [Medline].

  4. Hardie W, Bokulic R, Garcia VF, et al. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996 Jun. 22(6):1057-63. [Medline].

  5. Givan DC, Eigen H. Common pleural effusions in children. Clin Chest Med. 1998 Jun. 19(2):363-71. [Medline].

  6. Alkrinawi S, Chernick V. Pleural fluid in hospitalized pediatric patients. Clin Pediatr (Phila). 1996 Jan. 35(1):5-9. [Medline].

  7. Le Monnier A, Carbonnelle E, Zahar JR, et al. Microbiological diagnosis of empyema in children: comparative evaluations by culture, polymerase chain reaction, and pneumococcal antigen detection in pleural fluids. Clin Infect Dis. 2006 Apr 15. 42(8):1135-40. [Medline].

  8. Saglani S, Harris KA, Wallis C, Hartley JC. Empyema: the use of broad range 16S rDNA PCR for pathogen detection. Arch Dis Child. 2005 Jan. 90(1):70-3. [Medline].

  9. Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children, 1996 to 2001. Pediatr Infect Dis J. 2003 Jun. 22(6):499-504. [Medline].

  10. Hardie WD, Roberts NE, Reising SF, Christie CD. Complicated parapneumonic effusions in children caused by penicillin- nonsusceptible Streptococcus pneumoniae. Pediatrics. 1998 Mar. 101(3 Pt 1):388-92. [Medline].

  11. Quintero DR, Fan LL. Approach to pleural effusions and empyemas. Paediatr Respir Rev. 2004. 5 Suppl A:S151-2. [Medline].

  12. Hausdorff WP, Feikin DR, Klugman KP. Epidemiological differences among pneumococcal serotypes. Lancet Infect Dis. 2005 Feb. 5(2):83-93. [Medline].

  13. Byington CL, Korgenski K, Daly J, Ampofo K, Pavia A, Mason EO. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J. 2006 Mar. 25(3):250-4. [Medline].

  14. Eltringham G, Kearns A, Freeman R, et al. Culture-negative childhood empyema is usually due to penicillin-sensitive Streptococcus pneumoniae capsular serotype 1. J Clin Microbiol. 2003 Jan. 41(1):521-2. [Medline].

  15. Obando I, Munoz-Almagro C, Arroyo LA, et al. Pediatric parapneumonic empyema, Spain. Emerg Infect Dis. 2008 Sep. 14(9):1390-7. [Medline]. [Full Text].

  16. Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med. 2003 May 1. 348(18):1737-46. [Medline].

  17. Kaplan SL, Mason EO Jr, Wald ER, et al. Decrease of invasive pneumococcal infections in children among 8 children's hospitals in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine. Pediatrics. 2004 Mar. 113(3 Pt 1):443-9. [Medline].

  18. Poehling KA, Talbot TR, Griffin MR, et al. Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA. 2006 Apr 12. 295(14):1668-74. [Medline].

  19. Li ST, Tancredi DJ. Empyema Hospitalizations Increased in US Children Despite Pneumococcal Conjugate Vaccine. Pediatrics. 2009 Nov 30. [Medline].

  20. [Guideline] Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005 Feb. 60 Suppl 1:i1-21. [Medline]. [Full Text].

  21. Schultz KD, Fan LL, Pinsky J, et al. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics. 2004 Jun. 113(6):1735-40. [Medline].

  22. Gonzalez BE, Hulten KG, Dishop MK, Lamberth LB, Hammerman WA, Mason EO Jr, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus infection. Clin Infect Dis. 2005 Sep 1. 41(5):583-90. [Medline].

  23. Freij BJ, Kusmiesz H, Nelson JD, McCracken GH Jr. Parapneumonic effusions and empyema in hospitalized children: a retrospective review of 227 cases. Pediatr Infect Dis. 1984 Nov-Dec. 3(6):578-91. [Medline].

  24. Bryant RE, Salmon CJ. Pleural empyema. Clin Infect Dis. 1996 May. 22(5):747-62; quiz 763-4. [Medline].

  25. Cowan MR, Primm PA, Scott SM, Abramo TJ, Wiebe RA. Serious group A beta-hemolytic streptococcal infections complicating varicella. Ann Emerg Med. 1994 Apr. 23(4):818-22. [Medline].

  26. Brook I. Microbiology of empyema in children and adolescents. Pediatrics. 1990 May. 85(5):722-6. [Medline].

  27. Merino JM, Carpintero I, Alvarez T, et al. Tuberculous pleural effusion in children. Chest. 1999 Jan. 115(1):26-30. [Medline].

  28. Kim HJ, Lee HJ, Kwon SY, et al. The prevalence of pulmonary parenchymal tuberculosis in patients with tuberculous pleuritis. Chest. 2006 May. 129(5):1253-8. [Medline].

  29. Cruz AT, Starke JR. Clinical manifestations of tuberculosis in children. Paediatr Respir Rev. 2007 Jun. 8(2):107-17. [Medline].

  30. Panitch HB, Papastamelos C, Schidlow DV. Abnormalities of the pleural space. Taussig LM, Landau LI, eds. Pediatric Respiratory Medicine. 1999. 1178-96.

  31. Sassoon CS, Light RW. Chylothorax and pseudochylothorax. Clin Chest Med. 1985 Mar. 6(1):163-71. [Medline].

  32. Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009 Dec. 10(4):199-207. [Medline].

  33. Munoz-Almagro C, Jordan I, Gene A, et al. Emergence of invasive pneumococcal disease caused by nonvaccine serotypes in the era of 7-valent conjugate vaccine. Clin Infect Dis. 2008 Jan 15. 46(2):174-82. [Medline].

  34. Chonmaitree T, Powell KR. Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962-1980. Clin Pediatr (Phila). 1983 Jun. 22(6):414-9. [Medline].

  35. Mocelin HT, Fischer GB. Epidemiology, presentation and treatment of pleural effusion. Paediatr Respir Rev. 2002 Dec. 3(4):292-7. [Medline].

  36. Li ST, Tancredi DJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics. 2010 Jan. 125(1):26-33. [Medline].

  37. Byington CL, Spencer LY, Johnson TA, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 2002 Feb 15. 34(4):434-40. [Medline].

  38. Calbo E, Diaz A, Canadell E, et al. Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine. Clin Microbiol Infect. 2006 Sep. 12(9):867-72. [Medline].

  39. Desrumaux A, Francois P, Pascal C, et al. [Epidemiology and clinical characteristics of childhood parapneumonic empyemas]. Arch Pediatr. 2007 Nov. 14(11):1298-303. [Medline].

  40. Avansino JR, Goldman B, Sawin RS, Flum DR. Primary operative versus nonoperative therapy for pediatric empyema: a meta-analysis. Pediatrics. 2005 Jun. 115(6):1652-9. [Medline].

  41. Meyerovitch J, Shohet I, Rubinstein E. Analysis of thirty-seven cases of pleural empyema. Eur J Clin Microbiol. 1985 Jun. 4(3):337-9. [Medline].

  42. Barbas CS, Cukier A, de Varvalho CR, Barbas Filho JV, Light RW. The relationship between pleural fluid findings and the development of pleural thickening in patients with pleural tuberculosis. Chest. 1991 Nov. 100(5):1264-7. [Medline].

  43. Ampofo K, Byrington C. Management of Parapneumonic Empyema. Pediatr infec Dis J. 2007. 26:445-446.

  44. Lazarus AA, McKay S, Gilbert R. Pleural tuberculosis. Dis Mon. 2007 Jan. 53(1):16-21. [Medline].

  45. Pietsch JB, Whitlock JA, Ford C, Kinney MC. Management of pleural effusions in children with malignant lymphoma. J Pediatr Surg. 1999 Apr. 34(4):635-8. [Medline].

  46. Forbes BA. Critical assessment of gene amplification approaches on the diagnosis of tuberculosis. Immunol Invest. 1997 Jan-Feb. 26(1-2):105-16. [Medline].

  47. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972 Oct. 77(4):507-13. [Medline].

  48. Heffner JE, Brown LK, Barbieri CA. Diagnostic value of tests that discriminate between exudative and transudative pleural effusions. Primary Study Investigators. Chest. 1997 Apr. 111(4):970-80. [Medline].

  49. Sahn, SA. Pathogenesis and clinical features of diseases associated with a low pleural fluid glucose. Chretien, J, Bignon, J, Hirsch, A. The Pleura in Health and Disease. New York: Marcel Dekker; 1985. 267-285.

  50. Light RW, Girard WM, Jenkinson SG, George RB. Parapneumonic effusions. Am J Med. 1980 Oct. 69(4):507-12. [Medline].

  51. Pettersson T, Klockars M, Hellstrom PE. Chemical and immunological features of pleural effusions: comparison between rheumatoid arthritis and other diseases. Thorax. 1982 May. 37(5):354-61. [Medline]. [Full Text].

  52. Horowitz ML, Schiff M, Samuels J, Russo R, Schnader J. Pneumocystis carinii pleural effusion. Pathogenesis and pleural fluid analysis. Am Rev Respir Dis. 1993 Jul. 148(1):232-4. [Medline].

  53. Sahn SA, Willcox ML, Good JT Jr, Potts DE, Filley GF. Characteristics of normal rabbit pleural fluid: physiologic and biochemical implications. Lung. 1979. 156(1):63-9. [Medline].

  54. Villena Garrido V, Ferrer Sancho J, Hernandez Blasco L, et al. [Diagnosis and treatment of pleural effusion]. Arch Bronconeumol. 2006 Jul. 42(7):349-72. [Medline].

  55. Yam LT. Diagnostic significance of lymphocytes in pleural effusions. Ann Intern Med. 1967 May. 66(5):972-82. [Medline].

  56. Adelman M, Albelda SM, Gottlieb J, Haponik EF. Diagnostic utility of pleural fluid eosinophilia. Am J Med. 1984 Nov. 77(5):915-20. [Medline].

  57. Kalomenidis I, Light RW. Eosinophilic pleural effusions. Curr Opin Pulm Med. 2003 Jul. 9(4):254-60. [Medline].

  58. [Guideline] Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax. 2003 May. 58 Suppl 2:ii8-17. [Medline].

  59. Camargos P, Fonseca AC, Amantéa S, Oliveira E, Benfica MD, Chamone C. The role of latex agglutination test for the etiological diagnosis of pleural effusion in children and adolescents. Clin Respir J. 2015 Jul 6. [Medline].

  60. Lee YC, Rogers JT, Rodriguez RM, Miller KD, Light RW. Adenosine deaminase levels in nontuberculous lymphocytic pleural effusions. Chest. 2001 Aug. 120(2):356-61. [Medline].

  61. Greco S, Girardi E, Masciangelo R, Capoccetta GB, Saltini C. Adenosine deaminase and interferon gamma measurements for the diagnosis of tuberculous pleurisy: a meta-analysis. Int J Tuberc Lung Dis. 2003 Aug. 7(8):777-86. [Medline].

  62. Burgess LJ, Maritz FJ, Le Roux I, Taljaard JJ. Combined use of pleural adenosine deaminase with lymphocyte/neutrophil ratio. Increased specificity for the diagnosis of tuberculous pleuritis. Chest. 1996 Feb. 109(2):414-9. [Medline].

  63. Light RW. Clinical practice. Pleural effusion. N Engl J Med. 2002 Jun 20. 346(25):1971-7. [Medline].

  64. Chaignaud BE, Bonsack TA, Kozakewich HP, Shamberger RC. Pleural effusions in lymphoblastic lymphoma: a diagnostic alternative. J Pediatr Surg. 1998 Sep. 33(9):1355-7. [Medline].

  65. Qureshi NR, Gleeson FV. Imaging of pleural disease. Clin Chest Med. 2006 Jun. 27(2):193-213. [Medline].

  66. Wilson, AG. Pleura and pleural disorders. Armstrong P, Wilson AG, Dee P, et al,. Imaging of diseases of the chest. London: Mosby; 1995. 641-716.

  67. Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol. 1996 Feb. 3(2):103-9. [Medline].

  68. Moskowitz H, Platt RT, Schachar R, Mellins H. Roentgen visualization of minute pleural effusion. An experimental study to determine the minimum amount of pleural fluid visible on a radiograph. Radiology. 1973 Oct. 109(1):33-5. [Medline].

  69. Kelbel C, Borner N, Schadmand S, et al. [Diagnosis of pleural effusions and atelectases: sonography and radiology compared]. Rofo. 1991 Feb. 154(2):159-63. [Medline].

  70. Hirsch JH, Rogers JV, Mack LA. Real-time sonography of pleural opacities. AJR Am J Roentgenol. 1981 Feb. 136(2):297-301. [Medline].

  71. Lipscomb DJ, Flower CD, Hadfield JW. Ultrasound of the pleura: an assessment of its clinical value. Clin Radiol. 1981 May. 32(3):289-90. [Medline].

  72. Wolek R, Mason BJ, Reeser P, Zins JH. Pleural fluid: accuracy of computed tomography in differentiating exudates from transudates. Conn Med. 1998 May. 62(5):259-65. [Medline].

  73. Aquino SL, Webb WR, Gushiken BJ. Pleural exudates and transudates: diagnosis with contrast-enhanced CT. Radiology. 1994 Sep. 192(3):803-8. [Medline].

  74. Arenas-Jimenez J, Alonso-Charterina S, Sanchez-Paya J, et al. Evaluation of CT findings for diagnosis of pleural effusions. Eur Radiol. 2000. 10(4):681-90. [Medline].

  75. Donnelly LF, Klosterman LA. CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol. 1997 Jul. 169(1):179-82. [Medline].

  76. Jaffe A, Calder AD, Owens CM, Stanojevic S, Sonnappa S. Role of routine computed tomography in paediatric pleural empyema. Thorax. 2008 Oct. 63(10):897-902. [Medline].

  77. Calder A, Owens CM. Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 2009 Jun. 39(6):527-37. [Medline].

  78. Donnelly LF, Klosterman LA. The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 1998 Jun. 170(6):1627-31. [Medline].

  79. Calder A, Owens CM. Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 2009 Jun. 39(6):527-37. [Medline].

  80. Jaffe A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol. 2005 Aug. 40(2):148-56. [Medline].

  81. Light RW, Rodriguez RM. Management of parapneumonic effusions. Clin Chest Med. 1998 Jun. 19(2):373-82. [Medline].

  82. Teixeira LR, Sasse SA, Villarino MA, Nguyen T, Mulligan ME, Light RW. Antibiotic levels in empyemic pleural fluid. Chest. 2000 Jun. 117(6):1734-9. [Medline].

  83. Thys JP, Vanderhoeft P, Herchuelz A, Bergmann P, Yourassowsky E. Penetration of aminoglycosides in uninfected pleural exudates and in pleural empyemas. Chest. 1988 Mar. 93(3):530-2. [Medline].

  84. Thomson AH, Hull J, Kumar MR, et al. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax. 2002 Apr. 57(4):343-7. [Medline].

  85. Gilbert CR, Lee HJ, Skalski JH, Maldonado F, Wahidi M, Choi PJ, et al. The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies: A Multicenter Study. Chest. 2015 Sep 1. 148 (3):752-8. [Medline].

  86. Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005 Mar 3. 352(9):865-74. [Medline].

  87. Barbato A, Panizzolo C, Monciotti C, et al. Use of urokinase in childhood pleural empyema. Pediatr Pulmonol. 2003 Jan. 35(1):50-5. [Medline].

  88. Kilic N, Celebi S, Gurpinar A, et al. Management of thoracic empyema in children. Pediatr Surg Int. 2002 Jan. 18(1):21-3. [Medline].

  89. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg. 1997 Oct. 32(10):1473-5. [Medline].

  90. Krishnan S, Amin N, Dozor AJ, Stringel G. Urokinase in the management of complicated parapneumonic effusions in children. Chest. 1997 Dec. 112(6):1579-83. [Medline].

  91. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006 Jul 15. 174(2):221-7. [Medline].

  92. St Peter SD, Tsao K, Spilde TL, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective, randomized trial. J Pediatr Surg. 2009 Jan. 44(1):106-11; discussion 111. [Medline].

  93. Laisaar T, Pullerits T. Effect of intrapleural streptokinase administration on antistreptokinase antibody level in patients with loculated pleural effusions. Chest. 2003 Feb. 123(2):432-5. [Medline].

  94. Subramaniam R, Joseph VT, Tan GM, Goh A, Chay OM. Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children. J Pediatr Surg. 2001 Feb. 36(2):316-9. [Medline].

  95. Kurt BA, Winterhalter KM, Connors RH, Betz BW, Winters JW. Therapy of parapneumonic effusions in children: video-assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics. 2006 Sep. 118(3):e547-53. [Medline].

  96. Padman R, King KA, Iqbal S, Wolfson PJ. Parapneumonic effusion and empyema in children: retrospective review of the duPont experience. Clin Pediatr (Phila). 2007 Jul. 46(6):518-22. [Medline].

  97. Aziz A, Healey JM, Qureshi F, et al. Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect (Larchmt). 2008 Jun. 9(3):317-23. [Medline].

  98. Kim BY, Oh BS, Jang WC, et al. Video-assisted thoracoscopic decortication for management of postpneumonic pleural empyema. Am J Surg. 2004 Sep. 188(3):321-4. [Medline].

  99. Petrakis IE, Kogerakis NE, Drositis IE, et al. Video-assisted thoracoscopic surgery for thoracic empyema: primarily, or after fibrinolytic therapy failure?. Am J Surg. 2004 Apr. 187(4):471-4. [Medline].

  100. Gates RL, Caniano DA, Hayes JR, Arca MJ. Does VATS provide optimal treatment of empyema in children? A systematic review. J Pediatr Surg. 2004 Mar. 39(3):381-6. [Medline].

  101. Chan PW, Crawford O, Wallis C, Dinwiddie R. Treatment of pleural empyema. J Paediatr Child Health. 2000 Aug. 36(4):375-7. [Medline].

  102. McLaughlin FJ, Goldmann DA, Rosenbaum DM, et al. Empyema in children: clinical course and long-term follow-up. Pediatrics. 1984 May. 73(5):587-93. [Medline].

  103. Walker CA, Shirk MB, Tschampel MM, Visconti JA. Intrapleural alteplase in a patient with complicated pleural effusion. Ann Pharmacother. 2003 Mar. 37(3):376-9. [Medline].

  104. Wells RG, Havens PL. Intrapleural fibrinolysis for parapneumonic effusion and empyema in children. Radiology. 2003 Aug. 228(2):370-8. [Medline].

 
Previous
Next
 
Upright chest radiograph in a 3-year-old child with dyspnea and fever obtained 1 day before the development of the pleural effusion reveals pneumonia on the left side.
Upright chest radiograph in a 3-year-old child with dyspnea and fever reveals a large opacity on the left, with obliteration of the left costophrenic angle and a fluid stripe.
Left lateral decubitus image in a 3-year-old child with dyspnea and fever reveals minimal layering of the fluid, which indicates a loculated effusion.
Upright posteroanterior chest radiograph of a child with a right-sided pleural effusion.
Lateral view in a child with right-sided pleural effusion reveals a pleural effusion and a fluid level.
Right lateral decubitus radiograph in a child with a right-sided pleural effusion. Image reveals partial layering of the fluid in the right side.
Posteroanterior view in a patient with reaccumulated pleural effusion in the left side of the chest.
Left lateral view in a patient with reaccumulated pleural effusion on the left side of the chest reveals layering of the effusion.
Anteroposterior view of the chest reveals a large chylothorax on the right side of the chest in a neonate.
Anteroposterior view in a neonate reveals reaccumulation of the chylothorax in the right hemithorax after a chest tube has been removed.
Right lateral decubitus radiograph in a neonate reveals layering of the chylothorax effusion after a chest tube has been removed.
Ultrasonogram of the pleural effusion in a 3-year-old child with dyspnea and fever reveals many septa (arrowheads) and several large, loculated portions of fluid (arrows).
Ultrasonogram of the effusion in a 3-year-old child with dyspnea and fever reveals several fluid loculations (arrows) separated by septa (arrowheads). The lung is seen under the effusion.
CT scan of the chest in a 3-year-old child with dyspnea and fever reveals a left-sided effusion and underlying parenchymal infiltrate and atelectasis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.