Pleural empyema in children

Parapneumonic effusion and pleural empyema in children are more frequently encountered in the age group .2 years. This is explained by routine vaccination with the pneumococcal conjugated vaccine for Streptococcus pneumoniae in children aged,2 years. In every child treated for a lower respiratory tract infection, a complicated pneumonia should be suspected in case of clinical changes. Differential diagnosis and treatment are based on radiographic assessment with ultrasonography and computed tomographic scan of the chest, and biochemical and microbiological analysis of the pleural fluid. For early cases of parapneumonic effusion, drainage with a small drain (f16 French) is advised. In the case of loculation or a pleural peel, thoracoscopic surgery is indicated. For more severe cases, a thoracotomy or a conservative treatment with surgery in a second stage is advised, especially for lung abscesses. Intrapleural fibrinolysis has shown contradictory results, but a recent prospective trial showed great promise for the combination of fibrinolysis and DNAse for stage 1 and 2 complicated pneumonia. *Dept of Thoracic and Vascular Surgery, and Dept of Paediatrics, Antwerp University Hospital, Edegem, Public Health and Surveillance, Scientific Institute of Public Health, Brussels, and National Reference Centre for Pneumococci, University Hospitals Leuven, Leuven, Belgium.