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Pleural Thickening after Pleural Effusion: How can we Follow-Up in Children?
Tugba Ramasli Gursoy1, Tugba Sismanlar Eyuboglu2, Zeynep Reyhan Onay1
1Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey.
Insights
This study identified factors prolonging pleural thickening resolution after childhood parapneumonic effusion. Older age, fever, and higher effusion amounts were linked to delayed recovery in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Thoracic Medicine
- Infectious Diseases
Background:
- Pleural thickening is a common sequela of childhood parapneumonic effusion.
- Factors influencing the resolution time of pleural thickening remain poorly understood.
- This study addresses a critical knowledge gap in pediatric thoracic medicine.
Purpose of the Study:
- To investigate factors affecting the resolution time of pleural thickening following parapneumonic effusion in children.
- To identify clinical, laboratory, and imaging parameters associated with delayed recovery.
- To inform clinical management and follow-up strategies for pediatric patients.
Main Methods:
- Retrospective analysis of 91 pediatric patients diagnosed with pleural thickening post-parapneumonic effusion (2007-2018).
- Evaluation of patient demographics, clinical presentation, laboratory results, imaging findings (chest X-ray, ultrasonography), and treatment details.
- Statistical analysis to determine factors influencing pleural thickening resolving time.
Main Results:
- Pleural thickening resolved in 80% of patients, with a mean resolution time of 151 days.
- Delayed resolution was associated with older age, prolonged symptoms, pre-admission fever, lower oxygen saturation, crackles on examination, elevated white blood cell count, and higher pleural fluid density.
- Increased effusion volume, fibrinolytic use, and complications also significantly prolonged resolution time.
Conclusions:
- Pleural thickening following parapneumonic effusion in children typically resolves within 5 months.
- Patients with significant effusion, complications, or requiring fibrinolytic therapy need closer monitoring.
- Routine chest X-ray follow-up may not be necessary for uncomplicated cases.
Introduction:
No clear information exists about the factors affecting pleural thickening following parapneumonic effusion in children. We aimed to investigate factors that affect the resolving time of pleural thickening after parapneumonic effusion.
Methods:
Between the years of 2007-18, 91 patients, which were followed due to diagnosis of pleural thickening after parapneumonic effusion, were assessed. Ages, complaints, physical examination findings, laboratory results, chest x-ray and ultrasonography findings, treatments, duration of treatment and recovery time of the patients were examined terms in of pleural thickening resolving time.
Results:
The mean age of patients was 7.5 ± 5.0 years. Pleural thickening resolving time was 151 ± 6.8 days. The resolving time for pleural thickening was delayed with older ages, longer duration of complaints, fever before hospital admission and treatment, lower oxygen saturation at the time of admission, crackles in the physical examination, higher white blood cell count and pleural fluid density (p = 0.018, p = 0.001, p = 0.021, p = 0.020, p = 0.024, p = 0.025, p = 0.021, p = 0.019). In addition, the amount of effusion measured by thorax ultrasonography, fibrinolytic usage, and complications had a role in the delayed resolving time (p = 0.034, p = 0.001, p = 0.034). Pleural thickening resolved in 80% of the patients.
Conclusion:
In this report, 80% of pleural thickening, following parapneumonic effusion resolved within 5 months. Patients who do not have a complication during follow-up are not required to monitor with frequent chest x-ray. Patients with a higher amount of pleural effusion, complications and need for fibrinolytic treatment should be followed more carefully.
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