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CT in the evaluation of pleural versus pulmonary disease in children
1Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston.
Insights
Pediatric empyema typically resolves with antibiotics and drainage. However, some cases caused by non-Staphylococcus aureus infections require surgical decortication for symptom relief.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Thoracic Surgery
Background:
- Post-pneumonic empyema in children is commonly caused by Staphylococcus aureus.
- Standard treatment involves antibiotics and pleural space drainage, with high success rates.
Purpose of the Study:
- To investigate the management of pediatric empyema cases unresponsive to standard therapy.
- To identify clinical and radiological features associated with treatment failure.
Main Methods:
- Retrospective review of seven pediatric patients with persistent empyema.
- Analysis of computed tomography (CT) findings, including empyema rind extent.
- Microbiological analysis of pleural fluid to identify causative organisms.
Main Results:
- Seven children with empyema did not respond to antibiotics and drainage.
- CT scans revealed extensive empyema rinds in all non-responding patients.
- Causative organisms were identified as non-Staphylococcus aureus species.
Conclusions:
- Extensive empyema rind on CT suggests a need for further investigation beyond standard treatment.
- Infection with organisms other than Staphylococcus aureus may necessitate surgical intervention.
- Surgical decortication is effective for persistent pediatric empyema unresponsive to initial management.
Abstract:
Post pneumonic empyema in children is the result of infection by Staphylococcus aureus in approximately 80% of cases. Approximately 93% of children with empyema respond well to treatment with appropriate antibiotics and drainage of the pleural space. We present seven children in whom such therapy failed to produce an adequate response. Computed tomography alone clearly excluded persistent pneumonia as a cause of symptoms while in all seven patients revealing an unexpectedly extensive empyema rind. This information, coupled with the lack of clinical improvement and the specific organism isolated, led to a change in clinical management. These children were infected by organisms other than Staphylococcus aureus and required surgical decortication of the fibrinous pleural rind to alleviate persistent symptoms.