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Management of complicated parapneumonic effusions in children
G Peter Feola1, Lt Corey A Shaw, Laurie Coburn
1Department of Medical Imaging, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. pcpfeola@ihc.com
Techniques in Vascular and Interventional Radiology
|February 10, 2004
Summary
Intrapleural fibrinolysis with tissue plasminogen activator (tPA) effectively treats complicated parapneumonic effusions in children. This minimally invasive approach offers successful drainage and resolution, becoming a standard practice.
Area of Science:
- Pediatric Pulmonology
- Interventional Radiology
- Thoracic Surgery
Background:
- Complicated parapneumonic effusions are a significant cause of childhood morbidity.
- Evaluating novel treatment options is crucial for optimizing pediatric care.
Purpose of the Study:
- To assess the efficacy and safety of intrapleural tissue plasminogen activator (tPA) with pigtail catheter drainage for complicated parapneumonic effusions in pediatric patients.
Main Methods:
- Retrospective review of patient records and interventional radiology database.
- Analysis of 58 pediatric patients treated with intrapleural tPA and pigtail catheters.
- Standardized protocol developed by Interventional Radiology and Thoracic Surgery.
Main Results:
- Successful drainage and resolution in 54 of 58 effusions (93%) using percutaneous methods alone.
- No mortality or 30-day recurrence observed.
- Mean hospital stay of 9.1 days; patients afebrile within 72 hours. Average hemoglobin drop of 2 g/mL.
Conclusions:
- Intrapleural tPA via small-bore chest tubes is a safe and effective standard treatment for pediatric complicated parapneumonic effusions.
- Percutaneous drainage with tPA demonstrates high success rates, minimizing the need for surgical intervention.
- This approach leads to rapid resolution and shortens hospital stays for affected children.