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Semin Respir Crit Care Med 2008; 29(4): 414-426
DOI: 10.1055/s-2008-1081284
© Thieme Medical Publishers

Diagnosis and Management of Parapneumonic Effusions

Christopher Hampson1 , 2 , Julio A. Lemos1 , 2 , Jeffrey S. Klein1 , 2
  • 1Department of Radiology, Fletcher Allen Health Care, Burlington, Vermont
  • 2University of Vermont College of Medicine, Burlington, Vermont
Further Information

Publication History

Publication Date:
23 July 2008 (online)

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ABSTRACT

Parapneumonic effusions affect many patients and are associated with considerable morbidity and mortality. It is necessary to differentiate complicated effusions requiring intervention from uncomplicated effusions. Differentiation is achieved using clinical, pleural fluid, and imaging parameters. Intervention takes the form of blind catheter placement and drainage, image-guided catheter placement and drainage, and surgical decortication [video-assisted thoracoscopic surgery (VATS) or open thoracotomy]. Image-guided drainage and management of complicated effusions in adults and pediatric patients are safe and highly effective in select patients. The use of intrapleural fibrinolytic agents to facilitate resolution of complicated effusions is widespread and considered effective by many despite a lack of conclusive data supporting this method. We propose an algorithmic approach to patients with parapneumonic effusions and advocate image-guided drainage and management in patients likely to benefit from this treatment.

KEYWORDS

Parapneumonic - effusion - empyema - intervention - fibrinolytic

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Jeffrey S KleinM.D. 

Department of Radiology, Fletcher Allen Health Care

111 Colchester Ave., Burlington, VT 05401

Email: Jeffrey.Klein@uvm.edu