title: The approach to the patient with a parapneumonic effusion.
abstract: Parapneumonic effusions are seen in up to 57% of patients with pneumonia. The majority of these effusions are noninfected and resolve with standard antibiotic treatment for the associated pneumonia. However, parapneumonic effusions in a minority of cases become infected and require prompt chest tube drainage and occasionally thoracic surgery. Patients may present in a variety of ways from florid sepsis to weight loss and anorexia; such diversity mandates a high index of suspicion among physicians. The role of the combination of intrapleural deoxyribonuclease (DNase) and tissue plasminogen activator (t-PA) to aid fluid drainage shows promise but needs further assessment in large trials with surgery and mortality as primary end points.
authors.affiliation: Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom. johnwrightson@thorax.org.uk
authors.forename: John M
authors.initials: JM
authors.lastname: Wrightson
authors.forename: Robert J O
authors.initials: RJ
authors.lastname: Davies
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D015505:Chest Tubes; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D010996:Pleural Effusion / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011014:Pneumonia / Q000150:complications* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents