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Fifteen-minute consultation: A structured approach to children with parapneumonic effusion and empyema thoracis
  1. Joanna Kirstin B Dykes1,2,
  2. Adam Lawton3,
  3. Saskia Burchett4,
  4. Atul Gupta5,6
  1. 1 Paediatric Respiratory Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  2. 2 South Bristol Academy, University of Bristol Faculty of Health Sciences, Bristol, UK
  3. 3 Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
  4. 4 Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  5. 5 Respiratory Pediatrics, King's College Hospital NHS Foundation Trust, London, UK
  6. 6 Faculty of Life Sciences and Medicine, King's College London, London, UK
  1. Correspondence to Dr Atul Gupta, Respiratory Pediatrics, King's College Hospital NHS Foundation Trust, London, UK; atul.gupta{at}


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. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.

  • respiratory medicine
  • infectious disease medicine
  • paediatrics

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  • Contributors JKBD, AL and SB each wrote a section of the initial draft. JKBD prepared and edited the combined manuscript of the initial draft and created the original figures. AG critically revised the initial draft for intellectually important content. JKBD prepared the final draft of the manuscript. All authors reviewed and approved the final manuscript. AG acts as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.