PLEURAL EMPYEMA IN CHILDREN

Key words: Chest drain, Empyema, Thoracocentesis, Urokinase, Video-assisted thoracoscopic surgery

Parapneumonic effusion and empyema (the presence of pus in the pleural space) have an incidence of 3.3 per 100,000. An empyema could be suspected if a child remains pyrexial or unwell 48 hours after adequate antibiotic treatment; examination should include assessment of hydration, high respiratory frequence, the presence of a scoliosis and any underlying disorders. Investigation may include chest radiography, chest ultrasonography to assess the amount of fluid and differentiate free from loculated pleural fluid, diagnostic analysis of pleural fluid and eventually CT scan. Chest drain, intrapleural fibrinolytics and video-assisted thoracoscopic surgery (VATS) are the options for management of stages II-III of empyema, whereas stage I requires only antibiotic therapy.