Management of thoracic empyema in childhood: does the pleural thickening matter?

Abstract

Aims: To determine the clinical course and long term outcome of empyema treated without decortication. Methods: Fourteen consecutive admissions to one hospital were studied; radiological resolution and lung function were subsequently followed. The children were aged 2-14 years. All were treated with intravenous antibiotics and chest drain only. Results: All patients had extensive pleural thickening evident on chest x ray examination at the time of discharge, which resolved entirely over a period of 2-16 months. Lung function was measured in 13 children, and showed no evidence of restrictive or obstructive deficit: mean (SD) values as per cent predicted for height were: forced expiratory volume in one second (FEV 1 ) 107.5 (9.6), forced vital capacity (FVC) 95.5 (8.8), total lung capacity (TLC) 98.6 (20.7). Individual children all had values in the normal range (80-120 per cent predicted). Conclusion: Results suggest that decortication is not necessary in children to prevent long term problems with pleural thickening, and should be undertaken on the basis of the clinical picture (failure of fever resolution), rather than radiological appearance.T he management of thoracic empyema in children continues to evoke controversies from the past five decades.

Empyema Thoracis in Children: A Clinical Study

“…(36,37,38) In the present study, all patients responded to conservative management and one patient required decortication and one requiring VATS. Previous studies suggest a success rate of 61-100% with chest tube drainage and antibiotics.…”

Clinical, Radiological and Bacteriological Study of Empyema Thoracis in Children

“…no fever, normal breath sounds, resonant percussion note and x-ray evidence. Of the 6 which were cured with pleural thickening 17 , 4 cases did not show any further improvement during the follow up and two cases showed improvement to almost normal during the follow up. Of the two cases with pneumothorax one case improved with conservative management while the other case was lost for follow up.…”

Ventilation induced pneumothorax following resolved empyema

“…Radiological resolution following empyema in children varies widely. 11 Sonnappa et al 4 found that the majority of patients with treated empyema had abnormal CXRs at 6 months. Satish et al 11 found that complete radiological resolution was as variable as 2-16 months.…”