Microbiology and Management of Pleural Empyema
Empyema, the presence of pus in the pleural space, reflects a terminal stage of infection within this space. In children, this is usually secondary to pneumonia, although it may also arise from contiguous spread from another source such as subdiaphragmatic infection, lung, retropharyngeal, or paravertebral abscess, mediastinal lymph node, trauma, foreign body, or thoracic surgery. Differential diagnoses include pleural effusion caused by cardiac or renal failure, malignancy, particularly lymphoma, or connective tissue disease. Chest X-ray changes suggestive of effusion may also be caused by congenital abnormalities.
Cough, dyspnoea, and fever with clinical signs such as decreased or absent breath sounds, reduced chest expansion, and dullness to percussion are suggestive. Chest radiograph is the first initial helpful imaging. Ultrasound is extremely useful in detecting fluid, the size of effusion, and presence or absence of loculation. Computed tomography (CT) scanning adds...
KeywordsInvasive Pneumococcal Disease Pneumococcal Vaccine Chest Drain British Thoracic Society Pleural Empyema
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