Empyema or Pus in the Pleural Space in Children!!

The pleural space is a cavity that is present between the lungs and the chest wall. When pockets of pus get collected inside the pleural space it is termed as Empyema. Children with empyema can be quite unwell and require urgent medical care.

What is the main cause of empyema in children?
The most common cause of empyema or pus in the pleural cavity in children is secondary to bacterial pneumonia, which gets complicated. Other causes of empyema in children could be infections such as tuberculosis. Some children with chest trauma get blood in the pleural cavity with later gets infected to form an empyema.

How is empyema diagnosed?
Children who have pneumonia on the chest X Ray are at suspicion of having fluid inside the pleural cavity. In such situations, to confirm the presence of fluid an ultrasound of the chest is done. In case fluid is confirmed by an ultrasound a diagnostic thoracentesis is performed. This involves removing a small amount of fluid from the pleural space using a small needle under local anesthesia. The fluid which is removed is usually sent for analysis to the lab for cells, proteins, sugar and the presence of microorganisms. Occasionally, CT Scan of the chest might be required to estimate the amount of fluid inside the pleural cavity and the condition of the underlying lung.

What are the stages of empyema?
Empyema thoracis has been traditionally categorized based on three clinical phases: exudative, fibrinopurulent and organizing.

What are the complications of empyema?
Empyema can have immediate as well as long term consequences. Immediate complications could be sepsis or severe blood infection. Other immediate complications could be pneumothorax (air in the pleural space), bronchopleural fistulas (a tract between the airway and the pleural space) and empyema necessitans (extension of pus into the tissue of the chest wall). Long term complications which could happen are pleural scarring, trapped lung and decreased lung compliance.

What is the treatment of empyema in children?
The treatment of empyema in children involves prescription of antibiotics to control the infection. The usual antibiotics used for treatment of empyema in children of penicillin group of antibiotics. The duration of antibiotics which is required in empyema, is usually long, at least for the period of around 2 to 4 weeks. Initially, the antibiotics are given in the form of injection, usually for a period of around 7 to 10 days. Thereafter, the antibiotics are given in the form of a tablet or syrup to complete the course.

The treatment of empyema also involves drainage of pus from the pleural cavity. This is usually done by inserting a tube inside the pleural cavity called an intercostal chest tube. The tube is usually placed for a short period of around 3 to 5 days till all the pus is drained out. In some situations where the pus is thick, a medicine (urokinase or streptokinase) is installed through the intercostal tube to liquefy the pus inside the pleural cavity. In rare situations a surgeon might need to perform a procedure to peel away the pleural lining of the lung called decortication.

In case your child is diagnosed with empyema or pus inside the pleural cavity you need to get in touch with a child pulmonologist for proper treatment.

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