Pediatric empyema pneumonia is a lung infection that occurs when pus collects in the pleural space, the area between the lungs and chest wall. In this video, we cover the management of pediatric empyema, including diagnosis, treatment algorithms, imaging, and surgical versus non-surgical approaches with Dr. Aaron Garrison, a pediatric surgeon at Cincinnati Children’s.

Host: Brittany Levy

Key Takeaways:

• Pediatric empyema pneumonia requires a combination of medical and surgical management, but decision-making can be complex.

• Community-acquired pneumonia is a leading cause of hospitalization in children, yet bacterial pathogens are detected in only 15% of cases.

• Empyema progresses in three stages: exudative, fibrinopurulent, and organizing. The fibrinopurulent stage is when surgical intervention is often needed.

• Ultrasound is more sensitive than CT in detecting septations in pleural effusions and avoids radiation exposure.

• Chest tube drainage with fibrinolytics (such as TPA) has been shown to be a viable alternative to VATS, reducing hospital stays and costs.

• Some children with effusions may not require TPA—clinical improvement within 24 hours of drainage can indicate that it’s unnecessary.

• Inhaled foreign bodies, particularly peanuts, can mimic pneumonia and require a high index of suspicion for proper diagnosis.

• CT scans are now being used to diagnose airway foreign bodies with high reliability, reducing unnecessary bronchoscopies.

Further reading:

https://api.semanticscholar.org/CorpusID:53467976

Module 2 . Hemodynamic Disorders, 2015

https://thoracickey.com/nonmalignant-pleural-effusions/

Nonmalignant Pleural Effusions by John E. Heffner

https://www.ctsnet.org/article/thoracoscopic-decortication

Thoracoscopic Decortication by Christopher Komanapalli

https://publications.aap.org/neoreviews/article-abstract/18/9/e564/91880/A-Newborn-with-a-Cyst-in-the-Lung?redirectedFrom=fulltext

A Newborn with a Cyst in the Lung by Shabih Manzar, MD; Liaqat H. Khan, MD

https://journals.lww.com/ascp/fulltext/2019/07020/management_of_parapneumonic_effusion_and_empyema.1.aspx

Singh, S et.al. Management of parapneumonic effusion and empyema. The Journal of Association of Chest Physicians

https://pubmed.ncbi.nlm.nih.gov/23164006/

Islam S et.al. The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee

https://pubmed.ncbi.nlm.nih.gov/31973927/

Derderian SC et.al. Pediatric empyemas - Has the pendulum swung too far?

https://pubmed.ncbi.nlm.nih.gov/26382287/

Long AM et.al. 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center