Host: Brittany Levy
Key Takeaways:
• Pediatric empyema pneumonia requires a combination of medical and surgical management, but decision-making can be complex.
• Community-acquired pneumonia is a leading cause of hospitalization in children, yet bacterial pathogens are detected in only 15% of cases.
• Empyema progresses in three stages: exudative, fibrinopurulent, and organizing. The fibrinopurulent stage is when surgical intervention is often needed.
• Ultrasound is more sensitive than CT in detecting septations in pleural effusions and avoids radiation exposure.
• Chest tube drainage with fibrinolytics (such as TPA) has been shown to be a viable alternative to VATS, reducing hospital stays and costs.
• Some children with effusions may not require TPA—clinical improvement within 24 hours of drainage can indicate that it’s unnecessary.
• Inhaled foreign bodies, particularly peanuts, can mimic pneumonia and require a high index of suspicion for proper diagnosis.
• CT scans are now being used to diagnose airway foreign bodies with high reliability, reducing unnecessary bronchoscopies.
• Pulmonary abscesses in otherwise healthy children often resolve with antibiotics alone and rarely require drainage.
Further reading:
https://api.semanticscholar.org/CorpusID:53467976
Module 2 . Hemodynamic Disorders, 2015
https://thoracickey.com/nonmalignant-pleural-effusions/
Nonmalignant Pleural Effusions by John E. Heffner
https://www.ctsnet.org/article/thoracoscopic-decortication
Thoracoscopic Decortication by Christopher Komanapalli
https://publications.aap.org/neoreviews/article-abstract/18/9/e564/91880/A-Newborn-with-a-Cyst-in-the-Lung?redirectedFrom=fulltext
A Newborn with a Cyst in the Lung by Shabih Manzar, MD; Liaqat H. Khan, MD
https://journals.lww.com/ascp/fulltext/2019/07020/management_of_parapneumonic_effusion_and_empyema.1.aspx
Singh, Sarvinder; Singh, Santosh Kumar; Tentu, Ajai Kumar. Management of parapneumonic effusion and empyema. The Journal of Association of Chest Physicians 7(2):p 51-58, Jul–Dec 2019. | DOI: 10.4103/jacp.jacp_24_18
https://pubmed.ncbi.nlm.nih.gov/23164006/
Islam S, Calkins CM, Goldin AB, Chen C, Downard CD, Huang EY, Cassidy L, Saito J, Blakely ML, Rangel SJ, Arca MJ, Abdullah F, St Peter SD; APSA Outcomes and Clinical Trials Committee, 2011-2012. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 2012 Nov;47(11):2101-10. doi: 10.1016/j.jpedsurg.2012.07.047. PMID: 23164006.
https://pubmed.ncbi.nlm.nih.gov/31973927/
Derderian SC, Meier M, Partrick DA, Demasellis G, Reiter PD, Annam A, Bruny J. Pediatric empyemas – Has the pendulum swung too far? J Pediatr Surg. 2020 Nov;55(11):2356-2361. doi: 10.1016/j.jpedsurg.2019.12.017. Epub 2019 Dec 30. PMID: 31973927.
https://pubmed.ncbi.nlm.nih.gov/26382287/
Long AM, Smith-Williams J, Mayell S, Couriel J, Jones MO, Losty PD. ‘Less may be best’-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center. J Pediatr Surg. 2016 Apr;51(4):588-91. doi: 10.1016/j.jpedsurg.2015.07.022. Epub 2015 Aug 12. PMID: 26382287.
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