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Chest 2022 Jun 15. Epub 2022 Jun 15.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Background: Combination intrapleural fibrinolytic and enzyme therapy (IET) has been established as a therapeutic option in pleural infection. Despite demonstrated efficacy, there is a sparsity of studies specifically designed and adequately powered to address complications. The safety profile, the effects of concurrent therapeutic anticoagulation and the nature/extent of non-bleeding complications remain poorly defined. Read More

PLoS One 2022 25;17(5):e0268543. Epub 2022 May 25.

Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Changes in endothelial function are implicated in the spread of tuberculosis (TB). Studies suggest a role for the vascular endothelial growth factor (VEGF) in TB-related endothelial function changes. However, the findings of studies investigating the VGEF profile in TB are not consistent, and no formal systematic review and meta-analysis exists summarizing these studies. Read More

Pediatr Radiol 2022 Apr 22. Epub 2022 Apr 22.

Radiology Department, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Slot 105, 1 Children's Way, Little Rock, AR, 72202, USA.

Background: While chest tube placement with pleural fibrinolytic medication is the established treatment of pediatric empyema, treatment failure is reported in up to 20% of these children.

Objective: Standardizing fibrinolytic administration among interventional radiology (IR) physicians to improve patient outcomes in pediatric parapneumonic effusion.

Materials And Methods: We introduced a hospital-wide clinical pathway for parapneumonic effusion (1-2 mg tissue plasminogen activator [tPA] twice daily based on pleural US grade); we then collected prospective data for IR treatment May 2017 through February 2020. Read More

Pediatr Pulmonol 2022 Jul 3;57(7):1643-1650. Epub 2022 May 3.

Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Background: Parapneumonic effusions and empyema are the most frequent complication of pediatric pneumonia. Interventions include chest drain and fibrinolytics (CDF) or thoracoscopic surgery. CDF is considered less invasive, and more cost-effective though with higher rates of reintervention. Read More

Pediatr Pulmonol 2022 Jul 22;57(7):1625-1630. Epub 2022 Apr 22.

Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.

Aim: To evaluate the effectiveness of the systemic immune-inflammation index (SII) and other biomarkers in distinguishing parapneumonic effusion (PPE) and empyema.

Methods: Patients who were thought to have pleural effusion secondary to pneumonia in the pediatric emergency department (PED) between 2004 and 2021 were retrospectively evaluated. The patients were divided into two groups as empyema and PPE. Read More

BMJ Open 2022 03 9;12(3):e054236. Epub 2022 Mar 9.

Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.

Introduction: Pleural empyema is a frequent disease with a high morbidity and mortality. Current standard treatment includes antibiotics and thoracic ultrasound (TUS)-guided pigtail drainage. Simultaneously with drainage, an intrapleural fibrinolyticum can be given. Read More

Thorac Cancer 2022 04 4;13(8):1136-1142. Epub 2022 Mar 4.

Department of Respiratory Medicine, University of Occupational and Environmental Health Japan, Kitakyushu City, Japan.

Background: Pleural biopsies for investigating the causes of pleurisy are performed through modalities including needle biopsies, local anesthetic thoracoscopic procedures, and surgery (video-assisted thoracoscopic surgery and open thoracotomy). To date, there have been no large-scale nationwide epidemiological studies regarding pleurisy diagnosed via surgical pleural biopsy. This study examined the epidemiology of pleurisy diagnosed via surgical pleural biopsy in a Japanese nationwide administrative database. Read More

Gen Thorac Cardiovasc Surg 2022 Jul 3;70(7):634-641. Epub 2022 Feb 3.

Department of Thoracic Surgery, Ijinkai Takeda Hospital, 28-1 Isidamoriminami-cho, Kyoto-shi Fushimi-ku, Kyoto, 601-1495, Japan.

Objective: Thoracoscopic debridement under local anesthesia is a useful approach for complicated parapneumonic effusion or empyema (CPE) and is a less invasive procedure than video-assisted thoracoscopic surgery under general anesthesia. There are various methods of thoracoscopic debridement under local anesthesia, although the optimal timing of treatment is unknown. The objective of this study was to verify the efficacy and safety of our video-assisted flexible thoracoscopic debridement (VAFTS-D) procedure under local anesthesia, and to investigate the clinical features associated with the success of VAFTS-D. Read More

Radiol Case Rep 2022 Mar 10;17(3):869-874. Epub 2022 Jan 10.

Department of Surgical Diseases, Belarusian State Medical University, Dzerzhinsky Ave., 83, Minsk, Belarus. 220116.

Recurrent pyogenic effusion combined with bilateral pneumothorax is a rare complication associated with the COVID-19 infection. Current article presents the case report of a 68-year-old male with the severe community-acquired bilateral polysegmental viral COVID-19 pneumonia. Chest radiography on the 15th day after admission to the hospital showed the presence of air and pleural effusion in the right pleural cavity with collapse of the right lung. Read More

Cureus 2022 Jan 7;14(1):e21017. Epub 2022 Jan 7.

Thoracic Surgery, Maimonides Medical Center, Brooklyn, USA.

Pleural space infections have been described since the time of Hippocrates and to this day remains a significant pathology. Every year in the USA approximately there are one million hospital admissions for pneumonia with 20%-40% associated with some form of pleural space infections leading to pleural effusions with increased morbidity and mortality. Often, management of these effusions mandate combination of medical treatment and surgical drainage with debridement and decortication. Read More

J Thorac Dis 2021 Nov;13(11):6381-6389

Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Background: Parapneumonic empyema (PPE) management remains debated. Here we present the outcome of a comparable population with PPE treated over a 4-year period in two Thoracic Surgery University Centers with different approaches: one with an early "surgical" and the other with a "fibrinolytic" approach.

Methods: All operable patients with PPE managed in both centers between January 2014 and January 2018 were reviewed. Read More

Front Immunol 2021 2;12:780453. Epub 2021 Dec 2.

Department of Immunology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis (Tb). Patients with TPE or malignant pleural effusions (MPE) frequently have a similar lymphocytic pleural fluid profile. Since the etiology of PE in various diseases is different, identifying the cellular components may provide diagnostic clues for understanding the pathogenesis. Read More

Respir Med 2022 01 26;191:106706. Epub 2021 Nov 26.

Section of Pulmonary and Critical Care Medicine Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

Pleural effusion is a frequent complication of acute pulmonary infection and can affect its morbidity and mortality. The possible evolution of a parapneumonic pleural effusion includes 3 stages: exudative (simple accumulation of pleural fluid), fibropurulent (bacterial invasion of the pleural cavity), and organized stage (scar tissue formation). Such a progression is favored by inadequate treatment or imbalance between microbial virulence and immune defenses. Read More

Pediatr Infect Dis J 2022 01;41(1):20-23

Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba-city, Chiba, Japan.

Background: Pediatric parapneumonic effusion/ pleural empyema (PPE/PE) is a severe infectious condition, and its management should be guided by local epidemiology and the patient's medical history. This survey aimed to determine the clinical and bacteriologic features of PPE/PE in Japan.

Methods: A nationwide retrospective questionnaire survey was conducted, targeting 159 pediatric specialist training medical facilities for inpatients ≤18 years of age who were admitted for PPE/PE between January 2007 and December 2016. Read More

Am J Med Sci 2022 03 27;363(3):259-266. Epub 2021 Nov 27.

Department of Internal Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea.

Background: Data regarding predictors of the outcome in patients with community-acquired complicated parapneumonic effusion (CPPE) or empyema are insufficient. The aim of the present study was to investigate the prognostic factors in these patients.

Methods: Patients with community-acquired pneumonia (CAP) were classified into a CPPE or empyema group and a control group. Read More

Clin Chest Med 2021 12;42(4):637-647

Oxford University Hospitals NHS Foundation Trust; Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Headington OX3 9DU, UK.

The rising incidence and high morbidity of pleural infection remain a significant challenge to health care systems worldwide. With distinct microbiology and treatment paradigms from pneumonia, pleural infection is an area in which the evidence base has been rapidly evolving. Progress in recent years has revolved around characterizing the microbiome of pleural infection and the addition of new strategies such as intrapleural enzyme therapy to the established treatment pathway of drainage and antibiotics. Read More

Arch Dis Child Educ Pract Ed 2021 Nov 12. Epub 2021 Nov 12.

Respiratory Pediatrics, King's College Hospital NHS Foundation Trust, London, UK

Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis-frank pus in the pleural space. Read More

Curr Opin Pulm Med 2022 01;28(1):68-72

Interventional Pulmonology Service, Division of Pulmonary, Critical Care, and Sleep Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.

Purpose Of Review: Pleural disease guidelines have not been updated in a decade. Advances have been made in the diagnosis and management of pleural diseases since, with expanding evidence of the utility of medical thoracoscopy (MT) as a safe and effective tool.

Recent Findings: Although thoracic ultrasound has improved early determination of pleural disease etiology, thoracentesis remains limited, and pleural tissue is necessary for the diagnosis of undifferentiated exudative pleural effusions. Read More

Pulm Pharmacol Ther 2021 12 24;71:102081. Epub 2021 Sep 24.

Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA.

Background: Multiple studies describing the benefits of intrapleural fibrinolytic over placebo and DNase therapy have been published, but few have been published on intrapleural fibrinolytic and DNase therapy.

Objective: Our meta-analysis aims to compare the outcomes of surgical intervention, mortality, and hospital length of stay between intrapleural fibrinolytic and DNase therapy with either intrapleural fibrinolytic or DNase therapy alone in patients with pleural space infections.

Methods: We searched Pubmed, EMBASE, Web of Science, and Cochrane library databases for observational studies and randomized controlled trials (RCTs) containing comparative data for hospitalized adults and children with pleural infections receiving intrapleural therapy of fibrinolytic and DNase versus those receiving intrapleural fibrinolytic or DNase alone. Read More

Pediatr Pulmonol 2022 01 29;57(1):245-252. Epub 2021 Sep 29.

Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC MontLégia, Liège, Belgium.

Objective: Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children.

Methods: Retrospective single-center observational study of all children hospitalized with a diagnosis of parapneumonic pleural effusion during a 15-year period.

Results: We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range [IQR]) of 43 (33-61) months. Read More

J Thorac Dis 2021 Aug;13(8):5205-5222

Division of Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.

Disorders of the pleural space are quite common in the critically ill patient. They are generally associated with the underlying illness. It is sometimes difficult to assess for pleural space disorders in the ICU given the instability of some patients. Read More

J Cardiothorac Surg 2021 Aug 21;16(1):236. Epub 2021 Aug 21.

Division of Thoracic Surgery, Department of Surgery, University of Alberta, Alberta, Canada.

The use of intrapleural fibrinolytics for complicated parapneumonic effusion has been shown to be an effective and safe alternative to surgery. However, there is limited evidence about its use during pregnancy. We present a case and a review of the literature of pregnant women who had successful treatment of their complicated parapneumonic effusion with intrapleural fibrinolytics. Read More

Eur J Case Rep Intern Med 2021 15;8(7):002706. Epub 2021 Jul 15.

Department of Pulmonology, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical manifestations are diverse and can vary from mild respiratory symptoms to severe hypoxic respiratory failure. In severe cases, infection can cause gastrointestinal, renal, cardiac, neurological and haematological complications and result in multi-organ failure. Read More

Front Pediatr 2021 21;9:621943. Epub 2021 Jul 21.

Department of Pediatrics, Vega Baja Hospital, Orihuela, Spain.

The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD). Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018. Read More

Respir Med 2021 10 28;187:106553. Epub 2021 Jul 28.

The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA; South Shore Hospital, South Weymouth, MA, USA.

Pleural sepsis stems from an infection within the pleural space typically from an underlying bacterial pneumonia leading to development of a parapneumonic effusion. This effusion is traditionally divided into uncomplicated, complicated, and empyema. Poor clinical outcomes and increased mortality can be associated with the development of parapneumonic effusions, reinforcing the importance of early recognition and diagnosis. Read More

Chest 2021 11 19;160(5):1645-1655. Epub 2021 Jul 19.

School of Medicine and Public Health, Faculty of Health and Medicine and Priority Research Centre for Healthy Lungs, The University of Newcastle, and Hunter Medical Research Institute, Newcastle, NSW, Australia.

Background: Neutrophil extracellular traps (NETs) increasingly are implicated in acute and chronic conditions involving multiple organ systems.

Research Question: Are NET concentrations higher in parapneumonic effusions compared with effusions of other origin and does this reflect the inflammatory nature of these effusions?

Study Design And Methods: Patients (N = 101) seeking hospital treatment for undifferentiated pleural effusion underwent pleural fluid classification based on cytologic analysis results, biochemical findings, microbiological characteristics, and clinical judgement. Concentrations of NET markers (extracellular DNA [eDNA], citrullinated histone H3 [citH3]), neutrophils (α-defensins), and inflammation (IL-1β)-related proteins were quantified by enzyme-linked immunosorbent assay. Read More

Int J Gen Med 2021 14;14:3415-3429. Epub 2021 Jul 14.

Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain.

Pleural infection in adults has considerable morbidity and continues to be a life-threatening condition. The term "pleural infection" encompasses complicated parapneumonic effusions and primary pleural infections, and includes but is not limited to empyema, which refers to collection of pus in the pleural cavity. The incidence of pleural infection in adults has been continuously increasing over the past two decades, particularly in older adults, and most of such patients have comorbidities. Read More

J Investig Med 2021 12 19;69(8):1447-1452. Epub 2021 Jul 19.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Sonographic septation is associated with prolonged hospitalization and increased mortality in patients diagnosed with empyema. However, it is unknown whether sonographic septation is associated with complicated parapneumonic effusion (CPPE) or the need for invasive procedures among patients with pneumonia. In this retrospective study, we included 180 patients with non-purulent neutrophilic exudative pleural effusion secondary to pulmonary infections such as pneumonia and lung abscess. Read More

Pediatr Pulmonol 2021 09 20;56(9):2949-2957. Epub 2021 Jul 20.

Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.

Aim: The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand.

Methods: A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Read More

BMJ Case Rep 2021 May 24;14(5). Epub 2021 May 24.

Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. Read More