Pleural effusions are 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
Ultrasonographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
de Benedictis FM et al: Complicated pneumonia in children. Lancet. 396(10253):786-98, 2020
Konietzke P et al: The value of chest magnetic resonance imaging compared to chest radiographs with and without additional lung ultrasound in children with complicated pneumonia. PLoS One. 15(3):e0230252, 2020
Liszewski MC et al: Lung magnetic resonance imaging for pneumonia in children. Pediatr Radiol. 47(11):1420-30, 2017
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
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
Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
Calder A et al: Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 39(6):527-37, 2009
Hernández-Bou S et al: Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol. 44(12):1192-200, 2009
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
Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
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
Ramnath RR et al: Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics. 101(1 Pt 1):68-71, 1998
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 are 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
Ultrasonographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
de Benedictis FM et al: Complicated pneumonia in children. Lancet. 396(10253):786-98, 2020
Konietzke P et al: The value of chest magnetic resonance imaging compared to chest radiographs with and without additional lung ultrasound in children with complicated pneumonia. PLoS One. 15(3):e0230252, 2020
Liszewski MC et al: Lung magnetic resonance imaging for pneumonia in children. Pediatr Radiol. 47(11):1420-30, 2017
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
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
Heffner JE et al: Diagnostic utility and clinical application of imaging for pleural space infections. Chest. 137(2):467-79, 2010
Calder A et al: Imaging of parapneumonic pleural effusions and empyema in children. Pediatr Radiol. 39(6):527-37, 2009
Hernández-Bou S et al: Pediatric parapneumonic pleural effusion: epidemiology, clinical characteristics, and microbiological diagnosis. Pediatr Pulmonol. 44(12):1192-200, 2009
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
Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
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
Ramnath RR et al: Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics. 101(1 Pt 1):68-71, 1998
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
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