Parapneumonic empyema in children: diagnosis and management

Parapneumonic effusion can be a significant problem if it is not recognized and treated promptly. The amount of pleural fluid at presentation is usually small and may not be detected on physical examination. If pleural fluid is seen on radiographs, thoracentesis must be performed. Early, free-flowing parapneumonic effusions usually respond clinically to antibiotic therapy without the necessity of draining the pleural space. Distinguishing between exudative effusion and empyema is crucial. Failure of effusion or empyema to respond to the treatment is usually due to failure to adequately drain the pleural space or inappropriate antibiotic therapy. If chest tube drainage does not result in a lower temperature and an appropriate clinical response within a few days, further evaluation by computed tomographic scanning and surgical consultation are indicated. In patients with pleural effusion and empyema that responds poorly to medical and/or surgical therapy, underlying causes or associated debilitating disease should be excluded.