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Paediatric Pulmonology and Allergology
2003 April, Vol. VI, No. 1 (pp.2124-2133)
The child with pleural effusion
Anne H. Thomson
Under normal physiological conditions, pleural fluid is filtered at the parietal pleura. It is only when there is an imbalance between pleural fluid formation and its dreinage that a pleural effusion will result. There are a number of pathways which lead to excess accumulation of pleural liquid. The commonest is inflammation with alteration of vascular filtration and absorption; this is usually secondary to infection. An increase in either systemic or venous pulmonary pressures, a decrease in osmotic pressure, an impaired or impeded lymphatic, or a vascular accident can all result in a pleural effusion. In most cases the aetiology of the pleural effusion will be obvious and the investigation and general management will be that of the underlying disorder. However, where the aetiology is unclear, obtaining a sample of pleural fluid for analysis is essential. Pleural effusions are traditionally categorized as either transudates or exudates. Treatment is primarily directed at the underlying disorder however, if an effusion is large enough to be causing significant respiratory or cardiovascular compromise then drainage is indicated. When an empyema develops, drainage is required in addition to antibioticotherapy. For children in the western world, the morbidity from empyema has improved dramatically in recent years.