eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Pleural Effusion: Follow-up

Author: Ibrahim Abdulhamid, MD, Assistant Professor of Pediatrics, Wayne State University; Director of Pediatric Pulmonary Medicine, Clinical Director of Pediatric Sleep Laboratory, Children's Hospital of Michigan
Coauthor(s): Debbie S Toder, MD, Director of Cystic Fibrosis Center, Department of Pediatrics, Division of Pulmonary Medicine, Assistant Professor, Wayne State University and Children's Hospital of Michigan; Vandana Batra, MD, Consulting Staff, Baybees Pediatrics
Contributor Information and Disclosures

Updated: Apr 22, 2008

Follow-up

Further Inpatient Care

  • Follow-up is required, especially in complicated cases, to assess for evidence or progression of pleural fibrosis.
  • Children should be examined within 2-4 weeks after discharge, depending on the patient's clinical status, the severity of the effusion, and the use of outpatient IV antibiotics.

Further Outpatient Care

  • Some experts recommend serial chest radiography to ensure clearing.
  • Some perform CT scanning after the plain radiographs clear.

Deterrence/Prevention

  • Tests may need to be ordered to rule out immune dysfunction or other underlying systemic or local pulmonary disorders that cause empyema.

Complications

  • Complications are uncommon in properly treated parapneumonic effusions.
  • Possible complications include respiratory failure caused by massive fluid accumulation, septicemia, bronchopleural fistula, pneumothorax, or pleural thickening.

Prognosis

  • Most viral and mycoplasmal effusions spontaneously resolve.
  • Empyema has a complicated course if not treated and drained early, especially in children younger than 2 years. Thirty years ago, the mortality rate from empyema was 100%. At present, the mortality rate from empyema is 6-12% in infants younger than 1 year.
  • Most TB effusions completely resolve with the use of proper anti-TB agents.
  • Malignant effusion worsens the prognosis, depending on the underlying tumor.
  • Most patients recover well after parapneumonic effusion or empyema if appropriately treated.
    • Follow-up studies of children who have recovered from empyema are sparse but the data are encouraging.
    • Most children had complete clinical recovery with no residual radiologic or lung function changes.
    • Most children return to normal health by 4 weeks, and their chest radiographs return to normal by 3-6 months.
  • McLaughlin et al evaluated the outcome of 16 children with pleural effusion over 11 years.34
    • Fourteen patients had chest-tube drainage, and limited thoracotomy was performed in 5 of 16 patients.
    • Thirteen children were monitored for a mean of 66 months after their discharge from the hospital (range, 5-150 mo), and 3 children underwent chest radiography at 1, 2, and 3 months after discharge. Eight children had normal chest radiographs at follow-up visits, 7 had slight pleural thickening, and 1 had moderate pleural thickening 7 months after discharge.
    • No correlation between lung volumes and chest radiographic changes were observed in 5 patients who had a total lung capacity of less than 89% of the predicted value.
  • Murphy et al reported the results of follow-up chest radiographs obtained 1 month to 7 years after discharge in 8 of 9 children with pneumococcal empyema.4 Radiologic improvement was usually not apparent for 1-2 weeks after the start of treatment. However, 6 patients had normal follow-up radiographs, and only 2 had minimal residual parenchymal or pleural thickening.
  • The same article by Murphy et al reported follow-up pulmonary function results performed in 5 of 9 patients who had pneumococcal empyema. Four of the 5 patients had some increase in their residual volume with no other evidence of obstructive lung disease or impaired long-term performance.
  • Redding et al described 15 children who underwent pulmonary function testing 2 years after developing empyema.22 No evidence of restriction was found, and only 7 children had mild obstruction. Most importantly, none reported reduced exercise tolerance. They observed no difference between children treated with and those treated without surgery.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Lack of early diagnosis and drainage of empyema, especially in young children
  • Failure to recognize pneumothorax after thoracentesis
  • Development of constrictive pleural fibrosis in inadequately treated infectious or hemorrhagic effusions
 


More on Pleural Effusion

Overview: Pleural Effusion
Differential Diagnoses & Workup: Pleural Effusion
Treatment & Medication: Pleural Effusion
Follow-up: Pleural Effusion
Multimedia: Pleural Effusion
References
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Further Reading

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Keywords

pleural effusion, fluid, pleural space, congestive heart failure, nephrosis, infectious effusion, bilateral effusion, pleural infection, empyema, Mycoplasma pneumoniae, Staphylococcus aureus pneumonia, Haemophilus influenzae type b, Streptococcus pneumoniae pneumonia, tuberculosis, TB, congenital effusion, chylothorax, intrathoracic lymphomas, lymphoblastic lymphoma, non-Hodgkin lymphoma, hemolytic uremic syndrome, pneumococcal empyema, bacteremia, malignant effusion, parapneumonic effusion, upper respiratory tract infection, bronchitis, pleurisy
 
subpulmonic fluid collection, abdominal distension, dyspnea, respiratory distress, systemic lupus erythematosus, pleural rub, congenital heart disease, CHD, methicillin-resistant Staphylococcus aureus, MRSA, varicella, Staphylococcus pyogenes, Hodgkin disease, Down syndrome, diaphragmatic hernia, hydrops fetalis, polyhydramnios, pulmonary hypoplasia, Lemierre syndrome, hemothorax, pulmonary infarction, postpericardiotomy syndrome

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Contributor Information and Disclosures

Author

Ibrahim Abdulhamid, MD, Assistant Professor of Pediatrics, Wayne State University; Director of Pediatric Pulmonary Medicine, Clinical Director of Pediatric Sleep Laboratory, Children's Hospital of Michigan
Ibrahim Abdulhamid, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Debbie S Toder, MD, Director of Cystic Fibrosis Center, Department of Pediatrics, Division of Pulmonary Medicine, Assistant Professor, Wayne State University and Children's Hospital of Michigan
Debbie S Toder, MD is a member of the following medical societies: American Academy of Pediatrics and American Thoracic Society
Disclosure: Nothing to disclose.

Vandana Batra, MD, Consulting Staff, Baybees Pediatrics
Vandana Batra, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Girish D Sharma, MD, Associate Professor, Department of Pediatrics, Rush University Medical Center, Rush Children's Hospital; Director of Pediatric Pulmonary Section and Rush Cystic Fibrosis 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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester;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.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Associate Professor, Department of Clinical Pediatrics, State University of New York at Stony Brook
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American Heart Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD, Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center; Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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