What is the best treatment for empyema?
The incidence of parapneumonic effusion complicating pneumonia in children has increased in the last decade (Eastham). Three stages of disease are recognised:(Balfour-Lynn). Stage 1: “exudative” fluid accumulates within the pleural space but is free flowing, and no loculations are present. Stage 2: “fibropurulent” the fluid becomes loculated due to the presence of fibrin. Stage 3: “organisational” there are multiple loculations and a thick pleural peel entraps the underlying lung. Following chest radiography, ultrasonography is able to estimate the size of the effusion, detect loculations and determine its echogenicity.2 Routine chest CT is usually not required but may be helpful in defining lung consolidation, abscesses and necrosis (Ampofo). The choice of therapy lies between conservative management (ie, continuation of IV antibiotics alone) which may lead to resolution of the empyema in 6080% of cases but often requires prolonged hospitalisation (Balfour-Lynn). chest drain insertion
