Chest
Clinical Investigations: TechniquesThoracoscopic Decortication as First-Line Therapy for Pediatric Parapneumonic Empyema: A Case Series
Section snippets
Patients and Data Collection
Sixteen children with parapneumonic empyema were treated by the authors between November 1997 and August 1998. Patients presenting with pneumonia (characterized by fever, cough, chest pain, and leukocytosis) were initially evaluated by routine chest radiograph. A presumptive diagnosis of parapneumonic empyema was made in those patients with radiographic evidence of infiltrates combined with a large pleural effusion, unbalanced air-fluid levels, or multiple loculations. Chest CT scanning was
Results
Of the 16 children treated for parapneumonic empyema, 9 were boys and 7 girls. All previously had been healthy, although two children had experienced recurrent bouts of otitis media. Ten children presented during the winter months. The average age was 5 years (range, 1 to 16 years). Thirteen children presented with fever. All 16 patients had leukocytosis. Unilateral effusion was present on all admission chest radiographs. Each child received broad-spectrum IV antibiotics.
Discussion
Since the clinical entity of empyema was first described, its optimal treatment has been continually debated.9 With the development of more potent antibiotics and the advent of newer techniques for pleural drainage, therapy has become more effective and less morbidity has occurred.
Although tube thoracostomy is effective in the treatment of many early empyemas, 18 to 60% of children do not respond to closed drainage.3, 10 Most children do not present during the first 24 to 72 h of empyema
Conclusion
Although our study is limited by its small size and lack of a randomized control group, we believe that parapneumonic empyema in children can be expeditiously diagnosed and treated by thoracoscopy and decortication when the child initially receives the anesthetic for chest tube placement. Thoracoscopy allows for the effective drainage of the pleural space with no additional morbidity and may result in a shorter hospital stay than tube thoracostomy alone. A larger, prospective study is warranted
ACKNOWLEDGMENT
The authors thank Ms. Cissy Moore-Swartz for her assistance with the manuscript.
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