eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Pleural Effusion: Multimedia

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

Multimedia

Upright chest radiograph in a 3-year-old child wi...Media file 1: Upright chest radiograph in a 3-year-old child with dyspnea and fever obtained one day before the development of the pleural effusion reveals pneumonia on the left side.
Upright chest radiograph in a 3-year-old child wi...

Upright chest radiograph in a 3-year-old child with dyspnea and fever obtained one day before the development of the pleural effusion reveals pneumonia on the left side.

Upright chest radiograph in a 3-year-old child wi...Media file 2: Upright chest radiograph in a 3-year-old child with dyspnea and fever (same patient as in Media file 1) reveals a large opacity on the left, with obliteration of the left costophrenic angle and a fluid stripe. These findings indicate a pleural effusion.
Upright chest radiograph in a 3-year-old child wi...

Upright chest radiograph in a 3-year-old child with dyspnea and fever (same patient as in Media file 1) reveals a large opacity on the left, with obliteration of the left costophrenic angle and a fluid stripe. These findings indicate a pleural effusion.

Left lateral decubitus image in a 3-year-old chil...Media file 3: Left lateral decubitus image in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-2) reveals minimal layering of the fluid, which indicates a loculated effusion.
Left lateral decubitus image in a 3-year-old chil...

Left lateral decubitus image in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-2) reveals minimal layering of the fluid, which indicates a loculated effusion.

Upright posterior anterior chest radiograph of a ...Media file 4: Upright posterior anterior chest radiograph of a child with a right-sided pleural effusion.
Upright posterior anterior chest radiograph of a ...

Upright posterior anterior chest radiograph of a child with a right-sided pleural effusion.

Lateral view in a child with right-sided pleural ...Media file 5: Lateral view in a child with right-sided pleural effusion (same patient as in Media file 4) reveals a pleural effusion and a fluid level.
Lateral view in a child with right-sided pleural ...

Lateral view in a child with right-sided pleural effusion (same patient as in Media file 4) reveals a pleural effusion and a fluid level.

Right lateral decubitus radiograph in a child wit...Media file 6: Right lateral decubitus radiograph in a child with a right-sided pleural effusion (same patient as in Media files 4-5). Image reveals partial layering of the fluid in the right side.
Right lateral decubitus radiograph in a child wit...

Right lateral decubitus radiograph in a child with a right-sided pleural effusion (same patient as in Media files 4-5). Image reveals partial layering of the fluid in the right side.

Posteroanterior view in a patient with reaccumula...Media file 7: Posteroanterior view in a patient with reaccumulated pleural effusion in the left side of the chest.
Posteroanterior view in a patient with reaccumula...

Posteroanterior view in a patient with reaccumulated pleural effusion in the left side of the chest.

Left lateral view in a patient with reaccumulated...Media file 8: Left lateral view in a patient with reaccumulated pleural effusion on the left side of the chest (same patient as in Media file 7) reveals layering of the effusion.
Left lateral view in a patient with reaccumulated...

Left lateral view in a patient with reaccumulated pleural effusion on the left side of the chest (same patient as in Media file 7) reveals layering of the effusion.

Anteroposterior view of the chest reveals a large...Media file 9: Anteroposterior view of the chest reveals a large chylothorax on the right side of the chest in a neonate.
Anteroposterior view of the chest reveals a large...

Anteroposterior view of the chest reveals a large chylothorax on the right side of the chest in a neonate.

Anteroposterior view in a neonate after birth (sa...Media file 10: Anteroposterior view in a neonate after birth (same infant as in Media file 9) reveals reaccumulation of the chylothorax in the right hemithorax after a chest tube was removed.
Anteroposterior view in a neonate after birth (sa...

Anteroposterior view in a neonate after birth (same infant as in Media file 9) reveals reaccumulation of the chylothorax in the right hemithorax after a chest tube was removed.

Right lateral decubitus radiograph in a neonate (...Media file 11: Right lateral decubitus radiograph in a neonate (same patient as in Media files 9-10) reveals layering of the chylothorax effusion after a chest tube was removed.
Right lateral decubitus radiograph in a neonate (...

Right lateral decubitus radiograph in a neonate (same patient as in Media files 9-10) reveals layering of the chylothorax effusion after a chest tube was removed.

Ultrasonogram of the pleural effusion in a 3-year...Media file 12: Ultrasonogram of the pleural effusion in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-3) reveals many septa (arrowheads) and several large, loculated portions of fluid (arrows).
Ultrasonogram of the pleural effusion in a 3-year...

Ultrasonogram of the pleural effusion in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-3) reveals many septa (arrowheads) and several large, loculated portions of fluid (arrows).

Ultrasonogram of the effusion in a 3-year-old chi...Media file 13: Ultrasonogram of the effusion in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-3) reveals several fluid loculations (arrows) separated by septa (arrowheads). The lung is seen under the effusion.
Ultrasonogram of the effusion in a 3-year-old chi...

Ultrasonogram of the effusion in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-3) 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 d...Media file 14: CT scan of the chest in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-3) reveals a left-sided effusion and underlying parenchymal infiltrate and atelectasis.
CT scan of the chest in a 3-year-old child with d...

CT scan of the chest in a 3-year-old child with dyspnea and fever (same patient as in Media files 1-3) reveals a left-sided effusion and underlying parenchymal infiltrate and atelectasis.

More on Pleural Effusion

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

References

  1. 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. Feb 15 2002;34(4):434-40. [Medline].

  2. 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. Mar 2006;25(3):250-4. [Medline].

  3. Asmar BI, Slovis TL, Reed JO, Dajani AS. Hemophilus influenzae type b pneumonia in 43 children. J Pediatr. Sep 1978;93(3):389-93. [Medline].

  4. Murphy D, Lockhart CH, Todd JK. Pneumococcal empyema: outcome of medical management. Am J Dis Child. Jul 1980;134(7):659-62. [Medline].

  5. Chartrand SA, McCracken GH. Staphylococcal pneumonia in infants and children. Pediatr Infect Dis. Jan-Feb 1982;1(1):19-23. [Medline].

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

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

  8. Wolfe WG, Spock A, Bradford WD. Pleural fluid in infants and children. Am Rev Respir Dis. Dec 1968;98(6):1027-32. [Medline].

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

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

  11. 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. Nov-Dec 1984;3(6):578-91. [Medline].

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

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

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

  15. Chiu CY, Wu JH, Wong KS. Clinical spectrum of tuberculous pleural effusion in children. Pediatr Int. Jun 2007;49(3):359-62. [Medline].

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

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

  18. Menezes-Martins LF, Menezes-Martins JJ, Michaelsen VS, et al. Diagnosis of parapneumonic pleural effusion by polymerase chain reaction in children. J Pediatr Surg. Jul 2005;40(7):1106-10. [Medline].

  19. Ramnath RR, Heller RM, Ben-Ami T, et al. Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics. Jan 1998;101(1 Pt 1):68-71. [Medline].

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

  21. Baranwal AK, Singh M, Marwaha RK, Kumar L. Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia. Arch Dis Child. Nov 2003;88(11):1009-14. [Medline].

  22. Redding GJ, Walund L, Walund D, et al. Lung function in children following empyema. Am J Dis Child. Dec 1990;144(12):1337-42. [Medline].

  23. Ginsburg CM, Howard JB, Nelson JD. Report of 65 cases of Haemophilus influenzae b pneumonia. Pediatrics. Sep 1979;64(3):283-6. [Medline].

  24. Chan W, Keyser-Gauvin E, Davis GM, Nguyen LT, Laberge JM. Empyema thoracis in children: a 26-year review of the Montreal Children's Hospital experience. J Pediatr Surg. Jun 1997;32(6):870-2. [Medline].

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

  26. 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. Mar 3 2005;352(9):865-74. [Medline].

  27. Hawkins JA, Scaife ES, Hillman ND, Feola GP. Current treatment of pediatric empyema. Semin Thorac Cardiovasc Surg. 2004;16(3):196-200. [Medline].

  28. Hope WW, Bolton WD, Stephenson JE. The utility and timing of surgical intervention for parapneumonic empyema in the era of video-assisted thoracoscopy. Am Surg. Jun 2005;71(6):512-4. [Medline].

  29. Doski JJ, Lou D, Hicks BA, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg. Feb 2000;35(2):265-8; discussion 269-70. [Medline].

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

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

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

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

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

  35. Beers SL, Abramo TJ. Pleural effusions. Pediatr Emerg Care. May 2007;23(5):330-4; quiz 335-8. [Medline].

  36. Byington CL, Samore MH, Stoddard GJ, Barlow S, Daly J, Korgenski K. Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis. Jul 1 2005;41(1):21-9. [Medline].

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

  38. Chiu CY, Wong KS, Huang YC, Lai SH, Lin TY. Echo-guided management of complicated parapneumonic effusion in children. Pediatr Pulmonol. Dec 2006;41(12):1226-32. [Medline].

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

  40. Hendren WH, Haggerty RJ. Staphylococcic pneumonia in infancy and childhood; analysis of seventy-five cases. J Am Med Assoc. Sep 6 1958;168(1):6-16. [Medline].

  41. Hilliard TN, Henderson AJ, Langton Hewer SC. Management of parapneumonic effusion and empyema. Arch Dis Child. Oct 2003;88(10):915-7. [Medline].

  42. Jaffe A, Cohen G. Thoracic empyema. Arch Dis Child. Oct 2003;88(10):839-41. [Medline].

  43. Knudtson J, Grewal H. Pediatric empyema--an algorithm for early thoracoscopic intervention. JSLS. Jan-Mar 2004;8(1):31-4. [Medline].

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

  45. [Best Evidence] 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. Sep 2006;118(3):e547-53. [Medline].

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

  47. McAdams HP, Erasmus J, Winter JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am. Jul 1995;33(4):655-78. [Medline].

  48. Montgomery M. Air and liquid in the pleural space. In: Chernick V, Boat TF, Kendig EL, eds. Kendig's Disorders of the Respiratory Tract. 1998:389-411.

  49. Ozcelik C, Ulku R, Onat S, et al. Management of postpneumonic empyemas in children. Eur J Cardiothorac Surg. Jun 2004;25(6):1072-8. [Medline].

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

  51. Satish B, Bunker M, Seddon P. Management of thoracic empyema in childhood: does the pleural thickening matter?. Arch Dis Child. Oct 2003;88(10):918-21. [Medline].

  52. Schaaf HS, Beyers N, Gie RP, et al. Respiratory tuberculosis in childhood: the diagnostic value of clinical features and special investigations. Pediatr Infect Dis J. Mar 1995;14(3):189-94. [Medline].

  53. Shoseyov D, Bibi H, Shatzberg G, et al. Short-term course and outcome of treatments of pleural empyema in pediatric patients: repeated ultrasound-guided needle thoracocentesis vs chest tube drainage. Chest. Mar 2002;121(3):836-40. [Medline].

  54. Stringel G, Hartman AR. Intrapleural instillation of urokinase in the treatment of loculated pleural effusions in children. J Pediatr Surg. Dec 1994;29(12):1539-40. [Medline].

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

  56. Virkki R, Juven T, Rikalainen H, et al. Differentiation of bacterial and viral pneumonia in children. Thorax. May 2002;57(5):438-41. [Medline].

  57. Waagner DC. The clinical presentation of tuberculous disease in children. Pediatr Ann. Oct 1993;22(10):622-8. [Medline].

Further Reading

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

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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.