Nelson Textbook of Pediatrics 22nd Edition | Accumulation of purulent exudate in the pleural space. Most common complication of bacterial pneumonia. Pathogens: Streptococcus pneumoniae (most common), Staphylococcus aureus (including MRSA), Streptococcus pyogenes (GAS), Haemophilus influenzae, anaerobes. Three stages: exudative (sterile effusion), fibrinopurulent (loculations, thick pus), organizing (fibrous peel, trapped lung). Diagnosis: CXR, ultrasound (loculations, septations), CT, thoracentesis (purulent fluid, pH <7.2, glucose <60, LDH >1000, positive Gram stain/culture). Treatment: IV antibiotics (ceftriaxone + vancomycin), chest tube drainage + intrapleural fibrinolytics (tPA/DNase) for loculated effusions, video-assisted thoracoscopic surgery (VATS) if fibrinolytics fail, open thoracotomy/decortication for chronic empyema.
🌐 paeds.online — Pakistan's Pediatric Platform| Stage | Characteristics | Treatment |
|---|---|---|
| Exudative (early) | Sterile effusion, free-flowing, pH >7.2 | Antibiotics alone (if small) or chest tube (if large) |
| Fibrinopurulent (loculated) | Thick pus, loculations, pH <7.2, glucose <60 | Chest tube + intrapleural fibrinolytics (tPA/DNase) or VATS |
| Organizing (chronic) | Fibrous peel, trapped lung | Open thoracotomy/decortication |