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Management and prognosis of parapneumonic effusion and empyema in children

Ibrahim A Janahi, MD
Khoulood Fakhoury, MD
Section Editors
Gregory Redding, MD
Morven S Edwards, MD
Deputy Editor
Alison G Hoppin, MD


Parapneumonic effusion is defined as pleural effusion associated with lung infection (ie, pneumonia). These effusions result from the spread of inflammation and infection to the pleura. Much less commonly, infections in other areas adjacent to the pleura, such as the retropharyngeal, vertebral, abdominal, and retroperitoneal spaces, may spread to the pleura resulting in the development of effusion.

Early in the course of parapneumonic effusion, the pleura becomes inflamed; subsequent leakage of proteins, fluid, and leukocytes into the pleural space forms the effusion. At the time of formation, the pleural effusion is usually sterile with a low leukocyte count. With time, bacteria invade the fluid, resulting in empyema, which is defined as the presence of grossly purulent fluid in the pleural cavity. The development of pleural empyema is determined by a balance between host resistance, bacterial virulence, and timing of presentation for medical treatment [1].

The management of parapneumonic effusion and empyema in children will be reviewed here. The epidemiology, etiology, pathophysiology, clinical presentation, and evaluation of parapneumonic effusion and empyema in children are discussed separately. (See "Epidemiology; clinical presentation; and evaluation of parapneumonic effusion and empyema in children".)

The evaluation and management of parapneumonic effusion in adults also are discussed separately. (See "Diagnostic evaluation of a pleural effusion in adults: Initial testing" and "Imaging of pleural effusions in adults" and "Parapneumonic effusion and empyema in adults".)


Parapneumonic effusion is defined as pleural effusion associated with lung infection (ie, pneumonia). Early in the disease course, the effusion usually is free-flowing (also known as a "simple" effusion) and sterile.


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Literature review current through: Sep 2016. | This topic last updated: Nov 17, 2015.
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