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Semin Respir Crit Care Med 2010; 31(6): 706-715
DOI: 10.1055/s-0030-1269830
© Thieme Medical Publishers

The Approach to the Patient with a Parapneumonic Effusion

John M. Wrightson1 , 2 , Robert J. O Davies1 , 2
  • 1Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, United Kingdom
  • 2NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
Further Information

Publication History

Publication Date:
06 January 2011 (online)

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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.

KEYWORDS

Pleural empyema - pleural effusion - pneumonia - chest tubes

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John M WrightsonM.A. 

Oxford Pleural Unit, Oxford Centre for Respiratory Medicine

Churchill Hospital, Oxford OX3 7LJ, UK

Email: johnwrightson@thorax.org.uk