Skip to main content
SpringerLink
Log in
Book cover

Imaging in Pediatric Pulmonology pp 249–263Cite as

Pleural Effusion and Pneumothorax

  • Chapter
  • First Online:

  • 1957 Accesses

Abstract

The pleural space is bounded by two membranes: the visceral pleura covering the lung and the parietal pleura covering the chest wall, mediastinum and the diaphragm. Protein-containing fluid, derives from the systemic circulation, resides in the pleural space and is continuously absorbed by the lymphatics of the parietal pleura. Sub-atmospheric pressure in the pleural space aids in mechanical coupling of lung inflation throughout the respiratory cycle. Development of the pleura is notable by the third week of gestation along with the pericardial and peritoneal spaces. By 9 weeks of gestation, the pleural space becomes separated.

This is a preview of subscription content, 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   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
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

Learn about institutional subscriptions

References

  1. Moore KL. The developing human. 2nd ed. Philadelphia: WB Saunders; 1977. p. 145–55.

    Google Scholar 

  2. Noppen M, De Waele M, Li R, et al. Volume and cellular content of normal pleural fluid in humans examined by pleural lavage. Am J Respir Crit Care Med. 2000;162:1023–6.

    PubMed  CAS  Google Scholar 

  3. Staub NC, Wiener-Kronish JP, Albertine KH. Transport through the pleura: physiology of normal liquid and solute exchange in the pleural space. In: Chrétien J, Bignon J, Hirsch A, editors. The pleura in health and disease, Lung biology in health and disease, vol. 30. New York: Marcel Dekker; 1985. p. 169–93.

    Google Scholar 

  4. Negrini D, Ballard ST, Benoit JN. Contribution of lymphatic myogenic activity and respiratory movements to pleural lymph flow. J Appl Physiol. 1994;76:2267–74.

    PubMed  CAS  Google Scholar 

  5. Wang PM. Lai- Fook ST. Upward flow of pleural liquid near lobar margins due to cardiogenic motion. J Appl Physiol. 1992;73:2314–9.

    PubMed  CAS  Google Scholar 

  6. Miserocchi G, Pistolesi M, Miniati M, et al. Pleural liquid pressure gradients and intrapleural distribution of injected bolus. J Appl Physiol. 1984;56:526–32.

    PubMed  CAS  Google Scholar 

  7. Broaddus VC. Weiner- Kronish JP, Berthiaume Y, Staub NC. Removal of pleural liquid and protein by lymphatics in awake sheep. J Appl Physiol. 1988;64:384–90.

    PubMed  CAS  Google Scholar 

  8. Wang NS. Anatomy and physiology of the pleural space. Clin Chest Med. 1985;6:3–16.

    PubMed  CAS  Google Scholar 

  9. Light RW, MacGregor MI, Luchsinger PC, et al. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507–13.

    PubMed  CAS  Google Scholar 

  10. Kilbane BJ, Reynolds SL. Emergency department management of community-acquired methicillin-resistant Staphylococcus aureus. Pediatr Emerg Care. 2008;24(2):109–14.

    Article  PubMed  Google Scholar 

  11. Buckingham SC, King MD, Miller ML. Incidence and etiologies of complicated parapneumonic effusions in children 1996 to 2001. Pediatr Infect Dis J. 2003;22(6):499–504.

    PubMed  Google Scholar 

  12. Kuhn J. Caffey’s pediatric diagnostic imaging. 10th ed. Philadelphia: Mosby; 2004.

    Google Scholar 

  13. Chonmaitree T, Powell KR. Parapneumonic pleural effusion and empyema in children. Review of a 19-year experience, 1962-1980. Clin Pediatr (Phila). 1983;22(6):414–9.

    Article  CAS  Google Scholar 

  14. Freij BJ et al. Parapneumonic effusions and empyema in hospitalized children: a retrospective review of 227 cases. Pediatr Infect Dis. 1984;3(6):578–91.

    Article  PubMed  CAS  Google Scholar 

  15. Hardie W et al. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996;22(6):1057–63.

    Article  PubMed  CAS  Google Scholar 

  16. Rudikoff JC. Early detection of pleural fluid. Chest. 1980;77:109–11.

    Article  PubMed  CAS  Google Scholar 

  17. Moskowitz H, Platt RT, Schachar R, et al. Roentgen visualization of minute pleural effusion. Radiology. 1973;109:33–5.

    PubMed  CAS  Google Scholar 

  18. Tsai T-H, Yang P-C. Ultrasound in the diagnosis and management of pleural disease. Curr Opin Pulm Med. 2003;9:282–90.

    Article  PubMed  Google Scholar 

  19. Davies CL, Gleeson FV. Diagnostic radiology. In: Light RW, Lee GYC, editors. Textbook of pleural diseases. London: Arnold; 2003. p. 210–37.

    Google Scholar 

  20. Kohan JM, Poe RH, Israel RH, et al. Value of chest ultrasonography versus decubitus roentgenography for thoracentesis. Am Rev Respir Dis. 1986;133:1124–6.

    PubMed  CAS  Google Scholar 

  21. Remy-Jardin M, Remy J, Deschildre F, et al. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology. 1996;200:699–706.

    PubMed  CAS  Google Scholar 

  22. MacDonald SL, Mayo JR. Computed tomography of acute pulmonary embolism. Semin Ultrasound CT MR. 2003;24:217–31.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Rees JH, Spencer DA, Parikh D, Weller P. Increase in incidence of childhood empyema in West Midlands, UK. Lancet. 1997;349:402.

    Article  PubMed  CAS  Google Scholar 

  25. Playfor SD, Smyth AR, Stewart RJ. Increase in incidence of childhood empyema. Thorax. 1997;52:932.

    PubMed  CAS  Google Scholar 

  26. Roxburgh CS, Youngson GG, Townend JA, Turner SW. Trends in pneumonia and empyema in Scottish children in the past 25 years. Arch Dis Child. 2008;93:316–8.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  28. Hardie W, Bokulic R, Garcia VF, et al. Pneumococcal pleural empyemas in children. Clin Infect Dis. 1996;22:1057–63.

    Article  PubMed  CAS  Google Scholar 

  29. Freij BJ, Kusmiesz H, Nelson JD, McCracken Jr GH. Parapneumonic effusions and empyema in hospitalized children: a retrospective review of 227 cases. Pediatr Infect Dis. 1984;3:578–91.

    Article  PubMed  CAS  Google Scholar 

  30. 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  Google Scholar 

  31. Rodgers BM, McGahren ED. Mediastinum and pleura. In: Oldham KT, Colombani PM, Foglia RP, Skinner MA, editors. Principles and practice of pediatric surgery. Philadelphia: Lippincott, Williams & Wilkins; 2005. p. 929–49.

    Google Scholar 

  32. Wheeler JG, Jacobs RF. Pleural effusions and empyema. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, editors. Textbook of pediatric infectious diseases. 5th ed. Philadelphia: Saunders; 2004. p. 320–30.

    Google Scholar 

  33. Wolach B, Morag H, Drucker M, Sadan N. Thrombocytosis after pneumonia with empyema and other bacterial infections in children. Pediatr Infect Dis J. 1990;9:718–21.

    Article  PubMed  CAS  Google Scholar 

  34. Bynum LJ, Wilson III JE. Characteristic of pleural effusions associated with pulmonary embolism. Arch Intern Med. 1976;136:159–62.

    Article  PubMed  CAS  Google Scholar 

  35. Light RW, Ball Jr WC. Glucose and amylase in pleural effusions. JAMA. 1973;225:257–9.

    Article  PubMed  CAS  Google Scholar 

  36. Rockey DC, Cello JP. Pancreaticopleural fistula: report of 7 patients and review of the literature. Medicine. 1990;69:332–44.

    Article  PubMed  CAS  Google Scholar 

  37. Lankisch PG, Droge M, Becher R. Pleural effusions: a new negative prognostic parameter for acute pancreatitis. Am J Gastroenterol. 1994;89:1849–51.

    PubMed  CAS  Google Scholar 

  38. Berger HW, Rammohan G, Neff MS, et al. Uremic pleural effusion: a study in 14 patients on chronic dialysis. Ann Intern Med. 1975;82:362–4.

    PubMed  CAS  Google Scholar 

  39. Rodelas R, Rakowski TA, Argy WP, et al. Fibrosing uremic pleuritis during hemodialysis. JAMA. 1980;243:2424–5.

    Article  PubMed  CAS  Google Scholar 

  40. Halla JT, Schrohenloher RE, Volanakis JE. Immune complexes and other laboratory features of pleural effusion. Ann Intern Med. 1980;92:748–52.

    PubMed  CAS  Google Scholar 

  41. Koster FT, McGregor DD, Mackaness GB. The mediator of cellular immunity: II. Migration of immunologically committed lymphocytes into inflammatory exudates. J Exp Med. 1971;133:400–9.

    Article  PubMed  CAS  Google Scholar 

  42. Horler AR, Thompson M. The pleural and pulmonary complications of rheumatoid arthritis. Ann Intern Med. 1959;51:1179–203.

    PubMed  CAS  Google Scholar 

  43. Walker WC, Wright V. Pulmonary lesions and rheumatoid arthritis. Medicine. 1968;47:501–19.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  45. Yarbrough JW, Sealy WC, Miller JA. Thoracic surgical problems associated with rheumatoid arthritis. J Thorac Cardiovasc Surg. 1975;68:347–54.

    Google Scholar 

  46. Vargas FS, Milanez JR, Filomeno LT, et al. Intrapleural talc for the prevention of recurrence in benign or undiagnosed pleural effusions. Chest. 1994;106:1771–5.

    Article  PubMed  CAS  Google Scholar 

  47. Light RW. Pleural diseases. 4th ed. Baltimore: Lippincott, Williams & Wilkins; 2001.

    Google Scholar 

  48. Stelzner TJ, King Jr TE, Antony VB, Sahn SA. The pleuropulmonary manifestations of the postcardiac injury syndrome. Chest. 1983;84:383–7.

    Article  PubMed  CAS  Google Scholar 

  49. Bladergroen MR, Lowe JE, Postlethwait RW. Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg. 1986;42:235–9.

    Article  PubMed  CAS  Google Scholar 

  50. Reeder LB, DeFilippi VJ, Ferguson MK. Current results of therapy for esophageal perforation. Am J Surg. 1995;169:615–7.

    Article  PubMed  CAS  Google Scholar 

  51. Castellino RA, Bellani FF, Gasparini M, Musumeci R. Radiographic findings in previously untreated children with non- Hodgkin’s lymphoma. Radiology. 1975;117:657–63.

    PubMed  CAS  Google Scholar 

  52. Celikoglu F, Teirstein AS, Krellenstein DJ, Strauchen JA. Pleural effusion in non Hodgkin’s lymphoma. Chest. 1992;101:1357–60.

    Article  PubMed  CAS  Google Scholar 

  53. Fisher AMH, Kendall B, VanLeuven BD. Hodgkin’s disease: a radiological survey. Clin Radiol. 1962;13:115–27.

    Article  PubMed  CAS  Google Scholar 

  54. Keller SM. Current and future therapy for malignant pleural effusion. Chest. 1993;103:63s–7.

    PubMed  CAS  Google Scholar 

  55. Teba L, Dedhia HV, Bowen R, Alexander JC. Chylothorax review. Crit Care Med. 1985;13:49–52.

    Article  PubMed  CAS  Google Scholar 

  56. Chernick V, Reed MH. Pneumothorax and chylothorax in the neonatal period. J Pediatr. 1970;76:624–32.

    Article  PubMed  CAS  Google Scholar 

  57. Yancy WS, Spock A. Spontaneous neonatal pleural effusion. J Pediatr Surg. 1967;2:313–9.

    Article  PubMed  CAS  Google Scholar 

  58. Strausser JL, Flye MW. Management of non traumatic chylothorax. Ann Thorac Surg. 1981;31:520–6.

    Article  PubMed  CAS  Google Scholar 

  59. Rubin JW, Moore HV, Ellison RG. Chylothorax: therapeutic alternatives. Am Surgeon. 1977;43:292–7.

    PubMed  CAS  Google Scholar 

  60. Light RW. Pleural diseases. Philadelphia: Lea & Febiger; 1990.

    Google Scholar 

  61. Romero-Candeira S, Fernandez C, Martin C, et al. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med. 2001;110:681–6.

    Article  PubMed  CAS  Google Scholar 

  62. Cavina G, Vichi G. Radiological aspects of pleural effusions in medical nephropathy in children. Ann Radiol Diagn. 1958;31:163–202.

    PubMed  CAS  Google Scholar 

  63. Nomoto Y, Suga T, Nakajima K, et al. Acute hydrothorax in continuous ambulatory peritoneal dialysis: a collaborative study of 161 centers. Am J Nephrol. 1989;9:363–7.

    Article  PubMed  CAS  Google Scholar 

  64. Sade RM, Wiles HB. Pleuroperitoneal shunt for persistent pleural drainage after Fontan procedure. J Thorac Cardiovasc Surg. 1990;100:621–3.

    PubMed  CAS  Google Scholar 

  65. Norris RM, Jones JG, Bishop JM. Respiratory gas exchange in patients with spontaneous pneumothorax. Thorax. 1968;23:427–33.

    Article  PubMed  CAS  Google Scholar 

  66. Baumann MH. Non-spontaneous pneumothorax. In: Light RW, Lee YCG, editors. Textbook of pleural diseases. London: Arnold; 2003. p. 464–74.

    Google Scholar 

  67. Murphy DG, Sloan EP, Hart RG, et al. Tension pneumothorax associated with hyperbaric oxygen therapy. Am J Emerg Med. 1991;9:176–9.

    Article  PubMed  CAS  Google Scholar 

  68. Mainini SE, Johnson FE. Tension pneumothorax complicating small-caliber chest tube insertion. Chest. 1990;97:759–60.

    Article  PubMed  CAS  Google Scholar 

  69. Moskowitz PS, Griscom NT. The medial pneumothorax. Radiology. 1976;120:143–7.

    PubMed  CAS  Google Scholar 

  70. Carr JJ, Reed CJ, Choplin RH, et al. Plain and computed radiography for detecting experimentally induced pneumothorax in cadavers: implications for detection in patients. Radiology. 1992;183:193–9.

    PubMed  CAS  Google Scholar 

  71. Collins CD, Lopez A, Mathie A, et al. Quantification of pneumothorax size on chest radiographs using interpleural distances: regression analysis based on volume measurements from helical CT. AJR Am J Roentgenol. 1995;165:1127–30.

    PubMed  CAS  Google Scholar 

  72. Henry M, Arnold T, Harvey J. BTS guidelines for the management of spontaneous pneumothorax. Thorax. 2003;58(Suppl II):II39–52.

    PubMed  Google Scholar 

  73. Northfield TC. Oxygen therapy for spontaneous pneumothorax. Br Med J. 1971;4:86–8.

    Article  PubMed  CAS  Google Scholar 

  74. Light RW. Manual aspiration: the preferred method for managing primary spontaneous pneumothorax? Am J Respir Crit Care Med. 2002;165:1202–3.

    Article  PubMed  Google Scholar 

  75. Ponn RB, Silverman HJ, Federico JA. Outpatient chest tube management. Ann Thorac Surg. 1997;64:1437–40.

    Article  PubMed  CAS  Google Scholar 

  76. Liu CM, Hang LW, Chen WK, et al. Pigtail tube drainage in the treatment of spontaneous pneumothorax. Am J Emerg Med. 2003;21:241–4.

    Article  PubMed  Google Scholar 

  77. Yim AP, Ng CS. Thoracoscopy in the management of pneumothorax. Curr Opin Pulm Med. 2001;7:210–4.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tel-Aviv Sourasky Medical Center, Dana Children’s Hospital, 6 Weizmann Street, Tel-Aviv, 64239, Israel

    Efraim Sadot MD

Authors
  1. Efraim Sadot MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Efraim Sadot MD .

Editor information

Editors and Affiliations

  1. Children's Hospital Boston, Dept. Radiology, Harvard Medical School, Longwood Ave. 300, Boston, 02115, Massachusetts, USA

    Robert H. Cleveland

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Sadot, E. (2012). Pleural Effusion and Pneumothorax. In: Cleveland, R. (eds) Imaging in Pediatric Pulmonology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-5872-3_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-5872-3_12

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-5871-6

  • Online ISBN: 978-1-4419-5872-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation