Related Experiment Video
Updated: Aug 31, 2026
International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Management of thoracic empyema in childhood: does the pleural thickening matter?
Insights
Pediatric empyema treated with antibiotics and chest drainage shows complete radiological resolution and normal lung function long-term. Decortication is not essential for preventing lasting pleural issues in children.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema is a serious pleural infection in children.
- Decortication is a surgical procedure sometimes used to treat empyema.
- The necessity of decortication for long-term outcomes is debated.
Purpose of the Study:
- To evaluate the clinical course and long-term outcomes of pediatric empyema treated conservatively.
- To assess the need for decortication in children with empyema.
Main Methods:
- Retrospective study of 14 children (aged 2-14) with empyema.
- Treatment involved intravenous antibiotics and chest drain only.
- Radiological resolution and pulmonary function tests were monitored post-treatment.
Main Results:
- All patients achieved complete radiological resolution of pleural thickening within 2-16 months.
- Pulmonary function tests in 13 children showed no restrictive or obstructive deficits.
- All measured lung function parameters (FEV1, FVC, TLC) were within the normal range.
Conclusions:
- Conservative management (antibiotics and chest drain) is effective for pediatric empyema.
- Decortication may not be necessary to prevent long-term pulmonary complications.
- Treatment decisions should prioritize clinical improvement over radiological findings.
Aims:
To determine the clinical course and long term outcome of empyema treated without decortication.
Methods:
Fourteen consecutive admissions to one hospital were studied; radiological resolution and lung function were subsequently followed. The children were aged 2-14 years. All were treated with intravenous antibiotics and chest drain only.
Results:
All patients had extensive pleural thickening evident on chest x ray examination at the time of discharge, which resolved entirely over a period of 2-16 months. Lung function was measured in 13 children, and showed no evidence of restrictive or obstructive deficit: mean (SD) values as per cent predicted for height were: forced expiratory volume in one second (FEV1) 107.5 (9.6), forced vital capacity (FVC) 95.5 (8.8), total lung capacity (TLC) 98.6 (20.7). Individual children all had values in the normal range (80-120 per cent predicted).
Conclusion:
Results suggest that decortication is not necessary in children to prevent long term problems with pleural thickening, and should be undertaken on the basis of the clinical picture (failure of fever resolution), rather than radiological appearance.
Related Concept Videos
01:27Pneumothorax-II
Clinical Manifestations:
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:30Pneumonia III: Complications and Assessment
01:13Pleura of the Lungs
01:26Pneumothorax-I
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.