Implications of Early Sonographic Evaluation of Parapneumonic Effusions in Children With Pneumonia

Abstract

Patients with a low-grade sonogram had similar length of hospitalization if treated with either nonoperative or operative measures. Patients with high-grade sonograms had significantly shorter length of hospitalization when treated with decortication. Our retrospective study suggests that patients with high-grade ultrasound studies treated nonoperatively do not benefit from pleural drainage procedures or chest tube placement. This study demonstrates the usefulness of early sonographic evaluation of parapneumonic effusions. A prospective study evaluating the usefulness of sonographic assessment of severity of disease in the treatment of children with parapneumonic effusions is warranted on the basis of our retrospective data.

Factors Influencing Length of Hospital Stay in Patients with Bacterial Pleural Effusion

“…We also found that hospitalization was significantly longer in patients requiring pleural drainage or decortication. This fi nding contrasts with other publications in which decreases in hospital stay were registered after surgical treatment with or without associated instillation of intrapleural fi brinolytics [18][19][20] . The reason for this difference may reside in the fact that decortication was performed earlier in these previous publications, whereas in our patients it was done after other therapies had failed (median 22.6 days).…”

Complicated pneumonia in children

“…Thoracic ultrasound is essential to determine the extent and nature of fluid collections ( fig. 3) although there is debate as to whether this is useful in predicting outcome [51,52]. Differentiation of solid and cystic areas in the pleural cavity is poor with ultrasound and, if there is any doubt about the diagnosis (for example, the onset of symptoms was insidious and inflammatory markers are only moderately elevated, raising the possibility of malignancy), computed tomography (CT) should be performed prior to making any further decisions on management [53].…”

Management of Community-Acquired Pneumonia in Hospitalized Children

“…Lung ultrasound is a superior tool for detecting loculations, septations, and fronds associated with empyema, and can differentiate pleural fluid from consolidated lung tissue [60,61]. Neither CXR nor ultrasound can definitively diagnose empyema, but children with high grade findings on ultrasound such as organization, septation, and fronds within the pleural fluid have improved outcomes when treated with operative drainage procedures [60].…”