Pediatric Evaluation of Parapneumonic Effusion with Community Acquired Pneumonia (CAP)

 

Patient selection:pediatric patient with community-acquired pneumonia (CAP) and a paranpneumonic effusion on chest imaging studies

 

Parameters:

(1) size of the effusion

(2) Gram stain and bacteriology (microbiology)

(3) respiratory compromise

Size of the Effusion	Microbiology	Respiratory Compromise	Risk
small (fluid < 10 mm on lateral decubitus or less than one quarter of hemithorax opacified)	NA	NA	low
moderate (not small or large)	negative or unknown	absent	low
moderate (ibid)	negative or unknown	present	moderate
moderate (ibid)	positive	NA	moderate
large (over half of hemithorax opacified)	positive	NA	high

 

where:

• An empyema is present if the effusion shows bacteria on Gram stain and/or culture.

 

Chest tube drainage is indicated for moderate and high risk effusions. Fibrinolytics or video-assisted thoracoscopic surgery may be used, especially if the effusion is complicated (loculated).

 

Sampling of the pleural fluid is not usually performed for a small effusion.

 

If the patient presents with a moderately-sized effusion and does not have respiratory compromise, then a simple thoracentesis may be performed to determine if an empyema is present. If a thoracentesis is not done initially then it should be considered if the infection does not resolve despite appropriate therapy or if the effusion worsens.