title: Management of complicated parapneumonic effusions in children.
abstract: Pneumonia with complicated parapneumonic effusion is a significant source of morbidity in children seen in our institution. This affords us the opportunity to evaluate new treatment options. In an effort to ensure that we provide quality care to these pediatric patients presenting with complicated parapneumonic effusions, we performed a retrospective review of patient records as well as our interventional radiology database. Fifty-eight patients were identified who were treated with intrapleural placement of pigtail catheters and administration of tPA. Successful drainage and resolution of 54 of the 58 effusions were achieved with percutaneous methods alone. There was no mortality or 30-day recurrence. Mean hospital stay was 9.1 days (range 5-21). On average, the chest catheter was removed on day 6 postplacement (range 1.5-20). tPA was administered intrapleurally, utilizing a standardized hospital protocol developed conjointly by Interventional Radiology and Thoracic Surgery. Patients were afebrile within 72 hours. In most patients, one catheter was placed. However, five patients had more than one catheter placed initially. Of the four patients that failed percutaneous tube therapy, three underwent video-assisted thoracic surgery (VATS) and one had open thoracotomy with decortication. The complication associated with this treatment was an average drop in hemoglobin of 2 g/mL. Based on our experience, tPA administered through a small-bore chest tube for drainage of complicated parapneumonic effusions has become our standard practice.
authors.affiliation: Department of Medical Imaging, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA. pcpfeola@ihc.com
authors.forename: G Peter
authors.initials: GP
authors.lastname: Feola
authors.forename: Lt Corey A
authors.initials: LC
authors.lastname: Shaw
authors.forename: Laurie
authors.initials: L
authors.lastname: Coburn
mesh_terms: D000293:Adolescent; D002404:Catheterization; D015505:Chest Tubes / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003287:Contrast Media; D004322:Drainage; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006776:Hospitals, Pediatric / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011014:Pneumonia / Q000150:complications* / Q000000981:diagnostic imaging; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014589:Utah
chemical_list: D003287:Contrast Media; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator