Parapneumonic effusions and empyema in hospitalized children: A retrospective review of 227 cases

A pleural effusion associated with pneumonia, lung abscess or bronchiectasis is termed parapneumonic.1 Effusions vary considerably with respect to amount, color, cellular content, biochemical composition and other characteristics.1 Empyema, by definition, is the presence of gross pus in the pleural cavity and represents an effusion containing great numbers of polymorphonuclear leukocytes and fibrin.2 Although several reports have dealt with various aspects of empyema in children,3”13 considerable ambiguity still exists as to the “proper” approach to diagnosis and management of patients with effusion or empyema. Differing definitions of empyema6”9,13”17 and personal preferences in therapeutic approach18,19 to such patients contribute to these difficulties. This report summarizes the experience with 227 children with parapneumonic effusions and empyema managed at this institution over a 19-year period. General guidelines for diagnosis and management of such patients are also reviewed.