Postpneumonic Empyema in Children: Retrospective, Single Institution Study

INTRODUCTION: Different approaches have been proposed for the diagnosis and treatment of empyema secondary due to pulmonary infections. The aim of this study was to present our experience of diagnostic and therapeutic procedures in children with empyema.
METHODS: Clinical data of children with empyema that were treated with chest drainage in a public hospital pediatric surgery clinic between 1993 and 2016 were reviewed retrospectively. Patients were evaluated in terms of intercostal chest tube drainage with physical examination, erect anteroposterior and/or lateral decubitus chest radiograph, serum laboratory tests, diagnostic thoracentesis and pleural fluid studies.
RESULTS: In a total of 70 patients; 39 males and 31 females with a mean age of 6.9 years (5 days-17 years) were treated. 55 (78.5%) patients were monitored with chest ultrasonography (US). Most common isolated bacteria were Staphylococcus aureus and Streptococcus pneumoniae. 8 patients underwent re-intubation due to the loculation of fluid or technical reasons. A total of 81 chest tubes were inserted in 70 patients. The tubes were removed within 3-41 days (mean 11 days). 21 patients had varying degrees of pleural thickening, pneumothorax developed due to pneumatoceles in 6 patients. Because of the risks and limited facilities, fibrinolytic agents and decortication were not applied. Families were informed about it. Pleural thickenings decreased mostly following the clinical improvement in 10-90 days (mean 20 days) and lungs re-expanded completely.
DISCUSSION AND CONCLUSION: X-ray, laboratory tests and US were sufficient for the diagnosis and follow-up of postpneumonic empyema. Treatment was successfully done by combining systemic antibiotics, closed intercostal chest tube drainage and chest physiotherapy. Although there is a long recovery time, this essential treatment should be considered as a primary choice.