The diagnosis and management of empyema in children: a comprehensive review from the APSA Outcomes and Clinical Trials Committee

J Pediatr Surg. 2012 Nov;47(11):2101-10. doi: 10.1016/j.jpedsurg.2012.07.047.


The aim of this study is to review the current evidence on the diagnosis and management of empyema. The American Pediatric Surgical Association Outcomes and Clinical Trials Committee compiled 8 questions to address. A comprehensive review was performed on each topic. Topics included the distinction between parapneumonic effusion and empyema, the optimal imaging modality in evaluating pleural space disease, when and how pleural fluid should be managed, the first treatment option and optimal timing in the management of empyema, the optimal chemical debridement agent for empyema, therapeutic options if chemical debridement fails, therapy for parenchymal abscess or necrotizing pneumonia and duration of antibiotic therapy after an intervention. The evidence was graded for each topic to provide grade of recommendation where appropriate.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Combined Modality Therapy
  • Debridement
  • Deoxyribonucleases / therapeutic use
  • Drainage
  • Empyema, Pleural* / diagnosis
  • Empyema, Pleural* / etiology
  • Empyema, Pleural* / therapy
  • Expectorants / therapeutic use
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Pleural Cavity / diagnostic imaging
  • Pleural Cavity / surgery
  • Pneumonia, Bacterial / complications
  • Thoracic Surgery, Video-Assisted
  • Tomography, X-Ray Computed
  • Ultrasonography


  • Anti-Bacterial Agents
  • Expectorants
  • Fibrinolytic Agents
  • Deoxyribonucleases