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Updated: May 21, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

Published on: November 10, 2023

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

Summary

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.

Keywords:

Empyema Fibrinolysis Minors Necrotizing Pleural Pneumonia Thoracoscopy

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Last Updated: May 21, 2026

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion

Published on: November 10, 2023

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.