)The incidence of pediatric empyema is increasing globally. It is usually a complication of pneumonia, with Streptococcus pneumoniae the most common organism identified. If untreated, the effusion progresses through three stages: exudative, fibropurulent, and organization. Early medical management may halt the progression. Chest X-ray and ultrasound are useful initial investigations, with CT of the chest reserved for complicated patients. The mainstay of treatment includes intravenous antibiotics and effusion drainage. Intrapleural fibrinolysis has improved the outcome. A mini thoracotomy or thoracoscopic debridement can produce effective drainage and lung re-expansion with a low recurrence. Thoracotomy and decortication is reserved for an organized empyema, with or without a bronchopleural fistula.
KeywordsEmpyema Fibrinolysis Decortication Thoracoscopic Thoracotomy
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