CLINICAL COURSE AND TREATMENT OF EMPYEMA IN CHILDREN

Background.- Purulent pleurisy has become rare. It is often masked by previous antibiotic treatment so that functional prognosis may be poor . Patients and methods.- Twenty children with purulent pleurisy of the large cavity admitted from 1987 to 1993 were included ill the study: there were nine infants (age 5 to 18 months) with pleuro-pulmonary sta phylococcal infection (group I) and 11 children (4-13 years) (group II ). Clinical, biological, bacteriological and radiologic findings were analysed retrospectively as was the outcome. Results.- Patients of gro up I were admitted in poor general condition. X-ray showed moderate ef fusion and characteristic signs of staphylococcal infection. The bacte ria identified in seven patients (77%) was S aureus. Recovery was rapi d with antibiotics and simple local treatment. X-rays were normal two months after hospital discharge in seven patients (77%). One infant pr esented cicatricial bullous emphysema which required segmental resecti on. Patients of group II were admitted for moderate respiratory signs after a relatively long delay (14 days) since the onset of symptoms. X -rays showed considerable effusion in all and mediastinal shift in fiv e patients (45%). Streptococcus pneumoniae was identified in one patie nt only. Local treatment of empyema was difficult; the effusion, alrea dy fibrinous, required repeated use of chest tubes in eight cases and surgical decortication in three. X-rays, performed 2 months after hosp ital discharge, were normal in only three patients. Long-term course w as nevertheless favorable since chest X-rays at 5 months were normal i n all children of both groups. Conclusions.- Early recognition of puru lent pleurisy is important in children aged over 3 years to ensure eff ective drainage before the effusion becomes fibrinous. All patients in whom the first tribe was inserted after more than 10 days hall a diff icult follow-up requiring repeated chest drainages or surgery. Ultraso nography was a useful aid for diagnosis and local treatment. Computed tomography was useful for adapting treatment after several days of cou rse.