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Parapneumonic Effusion and Empyema
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Pleural effusions classified as transudative or exudative
            • Transudative: Due to hydrostatic & oncotic imbalances
            • Exudative: Due to ↑ capillary permeability
          • Parapneumonic effusions are exudative
            • Stages of progression: Exudative (simple) → fibrinopurulent (complicated) → organized
            • Empyema is fibrinopurulent parapneumonic effusion

        IMAGING

        • Radiographic Findings

          • CT Findings

            • Ultrasonographic Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            Selected References

                            1. Long AM et al: 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center. J Pediatr Surg. 51(4):588-91, 2015
                            2. Islam S et al: The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 47(11):2101-10, 2012
                            3. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                            4. Calder A et al: Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 39(6):527-37, 2009
                            5. Hernández-Bou S et al: Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol. 44(12):1192-200, 2009
                            6. Kurian J et al: Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 193(6):1648-54, 2009
                            7. Light RW: Clinical practice. Pleural effusion. N Engl J Med. 346(25):1971-7, 2002
                            8. Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
                            9. Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
                            10. Donnelly LF et al: The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998
                            11. Ramnath RR et al: Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics. 101(1 Pt 1):68-71, 1998
                            12. Donnelly LF et al: CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol. 169(1):179-82, 1997
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Clinical Issues

                                  TERMINOLOGY

                                  • Definitions

                                    • Pleural effusions classified as transudative or exudative
                                      • Transudative: Due to hydrostatic & oncotic imbalances
                                      • Exudative: Due to ↑ capillary permeability
                                    • Parapneumonic effusions are exudative
                                      • Stages of progression: Exudative (simple) → fibrinopurulent (complicated) → organized
                                      • Empyema is fibrinopurulent parapneumonic effusion

                                  IMAGING

                                  • Radiographic Findings

                                    • CT Findings

                                      • Ultrasonographic Findings

                                        • Imaging Recommendations

                                          DIFFERENTIAL DIAGNOSIS

                                            PATHOLOGY

                                            • General Features

                                              CLINICAL ISSUES

                                              • Presentation

                                                • Demographics

                                                  • Natural History & Prognosis

                                                    • Treatment

                                                      Selected References

                                                      1. Long AM et al: 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center. J Pediatr Surg. 51(4):588-91, 2015
                                                      2. Islam S et al: The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee. J Pediatr Surg. 47(11):2101-10, 2012
                                                      3. Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
                                                      4. Calder A et al: Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 39(6):527-37, 2009
                                                      5. Hernández-Bou S et al: Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol. 44(12):1192-200, 2009
                                                      6. Kurian J et al: Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 193(6):1648-54, 2009
                                                      7. Light RW: Clinical practice. Pleural effusion. N Engl J Med. 346(25):1971-7, 2002
                                                      8. Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
                                                      9. Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
                                                      10. Donnelly LF et al: The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998
                                                      11. Ramnath RR et al: Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics. 101(1 Pt 1):68-71, 1998
                                                      12. Donnelly LF et al: CT appearance of parapneumonic effusions in children: findings are not specific for empyema. AJR Am J Roentgenol. 169(1):179-82, 1997