Pleural Effusion & Empyema

Causes of pleural effusion in children

• Infections: Bacterial, viral, or fungal infections, particularly pneumonia, are the leading causes of pleural effusion in children. 
• Heart failure: When the heart is unable to pump blood effectively, fluid can back up in the lungs, leading to pleural effusion.
• Liver or kidney disease: Conditions like cirrhosis of the liver or kidney failure can cause fluid retention.
• Autoimmune diseases: Conditions like lupus or rheumatoid arthritis can lead to inflammation in the pleura, causing fluid accumulation
• Cancer: Rarely, tumors in the lungs or nearby organs can cause fluid to accumulate in the pleural cavity.
• Trauma to the chest can cause blood to accumulate in the pleural cavity

Empyema is a more severe complication of pleural effusion where the fluid in the pleural space becomes infected and gets converted to pus. It is a serious condition that requires urgent medical attention.

Symptoms 

The symptoms of pleural effusion and empyema may overlap, but they can differ in severity and presentation.

Symptoms of pleural effusion:

• Chest pain especially when breathing deeply or coughing.
• Shortness of breath and fast breathing
• Cough
• Fever, if the pleural effusion is caused by infection.
• Fatigue or weakness

Symptoms of empyema are similar; it typically causes persistent high grade fever.

Diagnosing Pleural Effusion and Empyema in Children

• Chest X-ray
• Ultrasound of the chest
• CT scan of the chest
• Thoracentesis: A procedure where a needle is inserted into the pleural space to remove fluid for testing. This helps determine whether the fluid is sterile or infected.
• Blood tests: Blood cultures and a complete blood count (CBC) can help identify infection

Treatment for Pleural Effusion and Empyema in Children

Treatment depends on the severity of the condition and the underlying cause and in general aims to remove the accumulated fluid, treat the infection, and alleviate symptoms. In addition to antibiotics and fluid drainage, supportive care, including pain management and rest, is essential for recovery. In some cases, respiratory therapy may help improve lung function.