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Comparing Treatment Modalities For Parapneumonic Pleural Empyema In Children: What To Choose And When, A

Carolina Soares-Aquino1, Sofia Vasconcelos-Castro1, Norberto Estevinho1

  • 1Department of Paediatric Surgery, Centro Hospitalar Universitário de São João, Portugal.

Portuguese Journal of Cardiac Thoracic and Vascular Surgery
|May 19, 2026
PubMed

Insights

For pediatric parapneumonic pleural empyema (PPE), simple drainage is ineffective. Thoracoscopic decortication and fibrinolysis show similar effectiveness, but decortication offers a shorter treatment duration and is recommended when fibrinolysis is contraindicated.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Parapneumonic pleural empyema (PPE) is a frequent pediatric condition.
  • Optimal treatment strategies for pediatric PPE remain undetermined.
  • This study evaluates and contrasts different therapeutic approaches for PPE in children.

Purpose of the Study:

  • To compare the effectiveness and outcomes of various treatments for pediatric parapneumonic pleural empyema.
  • To identify the most suitable treatment based on resolution times, failure rates, and complications.
  • To provide evidence-based recommendations for managing pediatric PPE.

Main Methods:

  • Retrospective analysis of 77 pediatric PPE cases (2012-2024).
  • Evaluation of demographics, treatment timelines, resolution, failure rates, and complications.
  • Exclusion of simple effusions and bilateral pneumonias; lung necrosis contraindicating fibrinolysis.

Main Results:

  • Intrapleural fibrinolysis was the most common initial treatment (58%), followed by thoracoscopic decortication (29%).
  • Treatment failure rates were 100% for simple drainage, 22% for fibrinolysis, and 9% for thoracoscopic decortication.
  • Thoracoscopic decortication demonstrated a shorter treatment duration (13 days) compared to fibrinolysis (17 days) without increased complications.

Conclusions:

  • Simple drainage is not recommended for pediatric parapneumonic pleural empyema.
  • Thoracoscopic decortication and fibrinolysis are equally effective in terms of failure rates.
  • Thoracoscopic decortication is recommended for prompt use, especially when fibrinolysis is contraindicated due to necrotizing pneumonia, due to its shorter treatment duration.
Abstract

Keywords:
EmpyemaFibrinolysisMinorsNecrotizingPleuralPneumoniaThoracoscopy

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