Skip to main content
SpringerLink
Log in

Treatment of Empyema in Children

  • Chapter
  • First Online:
The SAGES Manual of Pediatric Minimally Invasive Surgery

  • 1227 Accesses

Abstract

Pediatric empyema continues to be a prevalent disease process in children. This chapter reviews the pathophysiology of fibrinopurulent pleural disease and outlines both the diagnostic and management considerations of simple and complicated parapneumonic effusions. This includes an overview of imaging modalities of chest radiographs (CXR), ultrasonography (US), and computed tomography (CT) in empyema detection. We will provide information on antibiotic duration. Treatment options are summarized including the use of antibiotics and their duration, thoracentesis, tube thoracostomy, and chemical and mechanical debridement.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Durbin WJ, Stille C. Pneumonia. Pediatr Rev. 2008;29(5):147–58.

    Article  PubMed  Google Scholar 

  2. Septimus EJ, et al. Pleural effusion and empyema. In: Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 2015, 70. p. 187–210, e2.

    Google Scholar 

  3. Jaffe A, Calder AD, Owens CM, et al. Role of routine computed tomography in paediatric pleural empyema. Thorax. 2008;63:897–902.

    Article  CAS  PubMed  Google Scholar 

  4. Sahn SA. State of the art: the pleura. Am Rev Respir Dis. 1988;138:184–234.

    Article  CAS  PubMed  Google Scholar 

  5. Aleman C, Alegre J, Monasterio J, et al. Association between inflammatory mediators and the fibrinolysis system in infectious pleural effusions. Clin Sci (Lond). 2003;105:601–7.

    Article  CAS  Google Scholar 

  6. Porcel JM, Vives M, Esquerda A. Tumor necrosis factor-alpha in pleural fluid: a marker of complicated parapneumonic effusions. Chest. 2004;125:160–4.

    Article  PubMed  Google Scholar 

  7. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax. 2005;60 Suppl 1:i1–21.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bradley JS, Byington CL, Shah SS, et al. Executive summary: the management of community acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Disease Society and the Infectious Disease Society of America. Clin Infect Dis. 2011;53:617–30.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hamm H, Light RW. Parapneumonic effusion and empyema. Eur Respir J. 1997;10:1150–6.

    Article  CAS  PubMed  Google Scholar 

  10. Buckingham S, King M, Miller M. Incidence and etiologies of complicated parapneumonic effusions in children. Pediatr Infect Dis. 2003;22:499–504.

    Google Scholar 

  11. McLaughlin F, Goldman D, Rosenbaum D, et al. Empyema in children: clinical course and long-term follow-up. Pediatrics. 1984;73:587–93.

    CAS  PubMed  Google Scholar 

  12. Goeman A, Kipur N, Toppare M, et al. Conservative treatment of empyema in children. Respiration. 1993;60:182–5.

    Google Scholar 

  13. Schultz KD, Fan L, Pinsky J, et al. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics. 2004;113:1735–40.

    Article  PubMed  Google Scholar 

  14. Light RW. Parapneumonic effusions and empyema. Clin Chest Med. 1985;6:55–62.

    CAS  PubMed  Google Scholar 

  15. Padman R, King KA, Iqbal S, et al. Parapneumonic effusion and empyema in children: Retrospective review of the duPont experience. ClinPediatr (Phila). 2007;46:518–22.

    Article  Google Scholar 

  16. Wong KS, Lin TY, Huang YC, et al. Scoring system for empyema thoracis and help in management. Indian J Pediatr. 2005;72:1025–8.

    Article  CAS  PubMed  Google Scholar 

  17. King S, Thomson A. Radiological perspectives in empyema. Br Med Bull. 2002;61:203–14.

    Article  PubMed  Google Scholar 

  18. Brixey AG, Luo Y, Skouras V, et al. The efficacy of chest radiographs in detecting parapneumonic effusions. Respirology. 2011;16:1000–4.

    Article  PubMed  Google Scholar 

  19. Calder A, Owens CM. Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 2009;39:527–37.

    Article  PubMed  Google Scholar 

  20. Kurian J, Levin TL, Han BK, et al. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 2009;193:1648–54.

    Article  PubMed  Google Scholar 

  21. Pillai D, Song X, Pastor W, et al. Implementation and impact of a consensus diagnostic and management algorithm for complicated pneumonia in children. J Investig Med. 2011;59:1221–7.

    Article  PubMed  Google Scholar 

  22. Shomaker KL, Weiner T, Esther Jr CR. Impact of an evidence-based algorithm on quality of care in pediatric parapneumonic effusion and empyema. Pediatr Pulmonol. 2011;46:722–8.

    Article  PubMed  Google Scholar 

  23. Balik M, Plasil P, Waldauf P, et al. Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med. 2006;32:318–21.

    Article  CAS  PubMed  Google Scholar 

  24. Eibenberger KL, Dock WI, Ammann ME, et al. Quantification of pleural effusions: sonography versus radiography. Radiology. 1994;191:681–4.

    Article  CAS  PubMed  Google Scholar 

  25. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.

    Article  CAS  PubMed  Google Scholar 

  26. McIntosh K. Community-acquired pneumonia in children. N Engl J Med. 2002;346:429–37.

    Article  PubMed  Google Scholar 

  27. Byington CL, Spencer LY, Johnson TA, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis. 2002;34:434–40.

    Article  PubMed  Google Scholar 

  28. Tan TQ, Mason Jr EO, Wald ER, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics. 2002;110:1–6.

    Article  PubMed  Google Scholar 

  29. Grijalva CG, Nuorti JP, Zhu Y, et al. Increasing incidence of empyema complicating childhood community acquired pneumonia in the United States. Clin Infect Dis. 2010;50:805–13.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Baranwal AK, Singh M, Marwaha RK, Kumar L. Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia. Arch Dis Child. 2003;88:1009–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Davies HE, Davies RJO, Davies CWH. Management of pleural infection in adults: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii41–53.

    Google Scholar 

  32. Islam S, Calkin CM, Goldin AB, et al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012;47:2101–10.

    Article  PubMed  Google Scholar 

  33. Carter E, Waldhausen J, Zhang W, et al. Management of children with empyema: pleural drainage is not always necessary. Pediatr Pulmonol. 2010;45:475–80.

    PubMed  Google Scholar 

  34. Soares P, Barreira J, Pissarra S, et al. Pediatric parapneumonic pleural effusions: experience in a university central hospital. Rev Port Pneumol. 2009;15:241–59.

    Article  PubMed  Google Scholar 

  35. Colice GL, Curtic A, Deslauriers J, et al. Medical and surgical treatment of parapneumonic effusions: an evidence based guideline. Chest. 2000;118:1158–71.

    Article  CAS  PubMed  Google Scholar 

  36. Shoseyov D, Bibi H, Shatzberg G, et al. Short-term course and outcome of treatments of pleural empyema in pediatric patients: repeated ultrasound-guided needle thoracocentesis vs chest tube drainage. Chest. 2002;121:836–40.

    Article  PubMed  Google Scholar 

  37. Epaud R, Aubertin G, Larroquet M, et al. Conservative use of chest-tube insertion in children with pleural effusion. Pediatr Surg Int. 2006;22:357–62.

    Article  CAS  PubMed  Google Scholar 

  38. Rahman NM, Maskell NA, Davies CW, et al. The Relationship between chest tube size and clinical outcome in pleural infection. Chest. 2010;137:536–43.

    Article  PubMed  Google Scholar 

  39. Lin CH, Lin WC, Chang JS. Comparison of pigtail catheter with chest tube for drainage of parapneumonic effusion in children. Pediatr Neonatol. 2011;52:337–41.

    Article  PubMed  Google Scholar 

  40. Wurnig PN, Wittmer V, Pridun NS, et al. Video-assisted thoracic surgery for pleural empyema. Ann Thorac Surg. 2006;81:309–13.

    Article  PubMed  Google Scholar 

  41. Hope WW, Bolton WD, Stephenson JE. The utility and timing of surgical intervention for parapneumonic empyema in the era of video-assisted thoracoscopy. Am Surg. 2005;71:512–4.

    PubMed  Google Scholar 

  42. Olgac G, Fazlioglu M, Kutlu CA. VATS decortication in patients with stage 3 empyema. Thorac Cardiovasc Surg. 2005;53:318–20.

    Article  CAS  PubMed  Google Scholar 

  43. Cheng G, Vintch JR. A retrospective analysis of the management of parapneumonic empyemas in a county teaching facility from 1992 to 2004. Chest. 2005;128:3284–90.

    Article  PubMed  Google Scholar 

  44. Tsao K, St Peter SD, Sharp SW, et al. Current application of thoracoscopy in children. J Laparoendosc Adv Surg Tech A. 2008;18:131–5.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kurt BA, Winterhalter KM, Connors RH, et al. Therapy of parapneumonic effusions in children: video assisted thoracoscopic surgery versus conventional thoracostomy drainage. Pediatrics. 2006;118:e547–53.

    Article  PubMed  Google Scholar 

  46. Gates RL, Hogan M, Weinstein S, et al. Drainage, fibrinolytics, or surgery: a comparison of treatment options in pediatric empyema. J Pediatr Surg. 2004;39:1638–42.

    Article  PubMed  Google Scholar 

  47. Aziz A, Healey JM, Qureshi F, et al. Comparative analysis of chest tube thoracostomy and video-assisted thoracoscopic surgery in empyema and parapneumonic effusion associated with pneumonia in children. Surg Infect (Larchmt). 2008;9:317–23.

    Google Scholar 

  48. Chiu CY, Wong KS, Huang YC, et al. Echo-guided management of complicated parapneumonic effusion in children. Pediatr Pulmonol. 2006;41:1226–32.

    Article  PubMed  Google Scholar 

  49. Freitas S, Fraga JC, Canani F. Thoracoscopy in children with complicated parapneumonic pleural effusion at the fibrinopurulent stage: a multi-institutional study. J Bras Pneumol. 2009;35:660–8.

    Article  PubMed  Google Scholar 

  50. Yao CT, Wu JM, Liu CC, et al. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase. Eur J Cardiothorac Surg. 2005;28:599–603.

    Article  Google Scholar 

  51. Ekingen G, Guvenc BH, Sozubir S, et al. Fibrinolytic treatment of complicated pediatric thoracic empyemas with intrapleural streptokinase. Eur J Cardiothorac Surg. 2004;26:503–7.

    Article  PubMed  Google Scholar 

  52. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg. 1997;32:1472–5.

    Article  Google Scholar 

  53. Barbato A, Panizzolo C, Monciotti C, et al. Use of urokinase in childhood pleural empyema. Pediatr Pulmonol. 2003;35:50–5.

    Article  CAS  PubMed  Google Scholar 

  54. Cochran JB, Tecklenberg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med. 2003;4:39–43.

    Article  PubMed  Google Scholar 

  55. Stringel G, Hartman AR. Intrapleural instillation of urokinase in the treatment of loculated pleural effusions in children. J Pediatr Surg. 1994;29:1539–40.

    Article  CAS  PubMed  Google Scholar 

  56. Thomson AH, Hull J, Kumar MR, et al. Randomised trial of intrapleural urokinase in the treatment of childhood empyema. Thorax. 2002;57:343–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Chen JP, Lue KH, Liu SC, et al. Intrapleural urokinase treatment in children with complicated parapneumonic effusion. Acta Paedtr Taiwan. 2006;47:61–6.

    Google Scholar 

  58. Cohen E, Weinstein M, Fisman DN. Cost-effectiveness of competing strategies for the treatment of pediatric empyema. Pediatrics. 2008;121(5):e1250–7.

    Article  PubMed  Google Scholar 

  59. Light RW, Nguyen T, Mulligan ME, Sasse SA. The in-vitro efficacy of varidase versus streptokinase or urokinase for liquefying thick purulent exudative material from loculated empyema. Lung. 2000;178:13–8.

    Article  CAS  PubMed  Google Scholar 

  60. Bouros D, Schiza S, Patsourakis G, Chalkiadakis G, et al. Intrapleural streptokinase versus urokinase in the treatment of complicated parapneumonic effusions: a prospective, double-blind study. Am J Respir Crit Care Med. 1997;155(1):291–5.

    Article  CAS  PubMed  Google Scholar 

  61. Sonnappa S, Cohen G, Owens CM, et al. Comparison of urokinase and video-assisted thoracoscopic surgery for treatment of childhood empyema. Am J Respir Crit Care Med. 2006;174:221–7.

    Article  PubMed  Google Scholar 

  62. St Peter SD, Tsao K, Spilde TL, et al. Thoracoscopic decortication vs tube thoracostomy with fibrinolysis for empyema in children: a prospective randomized trial. J Pediatr Surg. 2000;35:265–8.

    Article  Google Scholar 

  63. Marhuenda C, Barcelo C, Fuentes I, et al. Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial. Pediatrics. 2014;134(5):e1301–7.

    Article  PubMed  Google Scholar 

  64. Misthos P, Sepsas E, Konstantinou M, et al. Early use of intrapleural fibrinolytics in the management of postpneumonic empyema. A prospective study. Eur J Cardiothorac Surg. 2005;28:599–603.

    Article  PubMed  Google Scholar 

  65. Doski JJ, Lou D, Hicks BA, et al. Management of parapneumonic collections in infants and children. J Pediatr Surg. 2009;44:106–11.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Ashwini S. Poola & Shawn D. St. Peter

Authors
  1. Ashwini S. Poola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shawn D. St. Peter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shawn D. St. Peter .

Editor information

Editors and Affiliations

  1. Division of Pediatric Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA

    Danielle S. Walsh

  2. Northeast Ohio Medical College Division of Pediatric Surgery, Akron Children’s Hospital, Akron, Ohio, USA

    Todd A. Ponsky

  3. Division of Pediatric Surgery, Akron Children’s Hospital, Akron, Ohio, USA

    Nicholas E. Bruns

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Poola, A.S., St. Peter, S.D. (2017). Treatment of Empyema in Children. In: Walsh, D., Ponsky, T., Bruns, N. (eds) The SAGES Manual of Pediatric Minimally Invasive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-43642-5_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43642-5_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43640-1

  • Online ISBN: 978-3-319-43642-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation