Pleural Effusion in Children: A Review Article and Literature Review

摘要

Pediatrics pleural effusion is an abnormality that frequently develops from collection of fluids?in the pleural space and commonly caused by a primary phenomenon or secondary to variety of?disorders such as infections. This accumulated fluid can be originated from excessive filtration?or defective absorption caused by different infectious agents such as Streptococcus pneumoniae,?which is the most common, or non-infectious factors like lymphoma or congestive heart failure.?It may present a various range of complications from a self-limited one to respiratory failure.?Pediatrics pleural effusion is most commonly seen in boys and younger children. The incidence?and distribution of pleural effusion is increasing in most industrial countries according to the?population studies. The prognosis is highly related to the underlying disorder as well as treatment?approach. early drainage of fluid may dramatically reduce the rate of mortality and morbidity.Clinical manifestations are variable depended on the underlying disease, size, and location of?the effusion. They range from persistent fever, cough, anorexia, malaise, tachypnea, dyspnea,?and chest pain, like in infectious pneumonia, to abdominal pain, distension and vomiting. In?physical examinations a pleural rub may be the only initial manifestation during the early stage?of pleurisy. A large amount of fluid diminishes the chest excursion on the affected side and may?shift the mediastinum and displace the trachea and cardiac apex to the contralateral side,?unilaterally. Initial diagnostic test for ruling out the different causes of pleural effusion is?analyzing the pleural fluid apparently and biochemically. Also imaging tests could be used such?as chest radiography so as to ensure the existence of pleural effusion. Ultrasonography and?computed tomography (CT) scanning are also beneficial for a more accurate assessment. In most?affected cases removing underlying etiologies and also applying supportive care are sufficient?to heal effusion, which can range from antibiotic therapy and using fibrinolytics to chest tube?drainage. Surgical therapy in patients with pleural effusion with the failed medical management?has remained controversial, though. Thus, selection of the best management approach can resultin favorable outcomes and significantly reduces morbidity and mortality rates.